Oral
Answers to
Questions

Health and Social Care

The Secretary of State was asked—

Covid-19: PPE Procurement

Allan Dorans: What recent assessment he has made of the adequacy of the steps taken by his Department to secure value for money in procuring PPE during the covid-19 outbreak.

Steve Barclay: We procured personal protective equipment at pace so that we could protect the frontline and save lives. In a highly distorted market, we worked around the clock to secure the life-saving PPE that we needed.

Allan Dorans: The Secretary of State will be aware of the high-profile reports in the media regarding Baroness Mone and her connection with PPE Medpro, contact with Government Ministers and the use of a VIP lane in relation to the procurement of PPE. Will he assure me—and more importantly the public—that a full and thorough investigation will take place into these matters and that, following that investigation, the report will be made public?

Steve Barclay: I can do much better than that. We have commissioned a full investigation and inquiry into the Government’s handling of covid and, as part of that, I am sure that the inquiry will look at PPE. But it is important to put it into context. We secured 23.2 billion items of PPE, which was a huge step, done at pace, to help protect our frontline.

Lindsay Hoyle: We come to the SNP spokesperson.

Steven Bonnar: There are concerns that officials and high-ranking associates have reaped the financial benefits of a deadly disease, shamelessly profiteering on public funds. The SNP has long sought to highlight the Government’s rampant cronyism and corruption, and this PPE plundering is the most egregious case that we have seen so far. In Scotland, the Scottish Government have robust procedures in place to ensure protection of procurement in healthcare. How will the Secretary of State better regulate the cronyism of his colleagues? Will he commit now to scrapping the UK Government’s VIP lane for healthcare contracts?

Steve Barclay: Again, that ignores both the pressure of time at the start of the pandemic and the fact that there was international competition, with companies competing for scarce resources. It is also the case that although more than 19,000 companies were offering PPE, only 2,600 passed initial due diligence checks.

Hospital Bed Capacity

Andy Carter: What steps his Department is taking to increase hospital bed capacity.

Will Quince: To support operational resilience, the NHS has set out plans to increase hospital bed capacity by the equivalent of at least 7,000 general and acute beds during the winter. That is alongside £500 million of funding to support quick, safe discharge from hospital and free up capacity, and £1.5 billion of targeted investment funding for new surgical hubs, increasing bed capacity and equipment for elective care recovery.

Andy Carter: I am grateful for the Minister’s response. Over the last 20 years, Warrington has had among the highest level of new houses built in the north-west of England, but our healthcare infrastructure has not kept pace. We desperately need a new hospital. Our accident and emergency is at breaking point, we do not have enough beds and there is nowhere for those visiting to park their cars. In 2021, my NHS trust submitted a bid to the Department of Health and Social Care for a new hospital. Will he update us on where we are with that process?

Will Quince: I thank my hon. Friend, who has been a long-standing advocate for a new general hospital for Warrington. The expression of interest from the trust has been received. We are currently in the process of reviewing expressions of interest for the eight new hospitals and aim to announce a final decision by the end of the year. I recently met him to hear about the plans, and the people of Warrington could not have a greater champion than him.

Derek Twigg: May I associate myself with the remarks of the hon. Member for Warrington South (Andy Carter) about the need for investment in Warrington and Halton Hospitals NHS Trust? It is important that both hospitals have that investment. Part of the capacity problem is the lack of social care capacity in the community, whether in a home or in patients’ own homes. Just recently, I had an email from the chief executive of Whiston Hospital, a large acute hospital, where 115 patients were in beds when they did not need to be—they should have been going out of the hospital—out of a total of 721 adult acute beds. Is that not an example of where the Government are failing to provide enough social care out in the community?

Will Quince: We are investing £500 million to create another 200,000 social care placements, but we have significantly increased the number of physical beds available in our hospitals. In July, before we made the commitment to increase bed capacity, we had 96,375 general and acute beds; in October, we had 97,350. We  are also delivering that increased capacity outside of hospital through this winter by creating an extra 2,500 virtual ward beds.

Boris Johnson: Does my hon. Friend agree that it is high time the outstanding care and skill of Hillingdon Hospital staff was matched by commensurate outstanding facilities, and that it is therefore great news that Hillingdon is one of the 40 new hospitals that the Government are building by 2030? Can he confirm that the full funding package will be announced soon, so the whole project can proceed as soon as possible?

Will Quince: I thank my right hon. Friend for his question. The Secretary of State visited Hillingdon Hospital—a hospital I am also aware of—over the summer. There has been no greater champion of Hillingdon Hospital, or of the new hospitals programme more broadly, than my right hon. Friend. Currently, five hospital schemes are in construction, two are now completed and we aim to announce the next eight by the end of this year.

Sarah Champion: Two weeks ago, a 5-year-old constituent of mine, Yusuf Nazir, died because we no longer have intensive paediatric beds in Rotherham. September saw record-breaking ambulance handover delays and the proportion of patients waiting more than 12 hours in accident and emergency rose to 13.8%, nearly double last September’s figure. In the last 12 years, Rotherham’s NHS has been hollowed out. What is the Minister going to do to reverse that?

Will Quince: First, let me thank the hon. Lady for her question. I am very sorry to hear about the case she highlights. I understand she has written to the Secretary of State on this issue.
Ambulance waiting times are not where we want them to be. We have increased ambulance staff by 40% since 2010. We have invested, with just under 5,000 more staff in NHS 111; 2,500 more staff in call centres; an extra £450 million last year into A&E departments; the creation of the £500 million discharge fund, which will improve flow through hospitals; and 7,000 extra beds this winter. We understand the system is under considerable pressure. I would be very happy to meet the hon. Lady to discuss the challenges in her own trust.

Rosena Allin-Khan: The current state of mental health treatment sees increasing numbers of people languishing on waiting lists becoming more and more unwell, 1.1 million adults denied treatment, and children stuck in emergency departments for days waiting for mental health beds. Are the Government proud that a systemic cutting of a quarter of NHS mental health beds over the last 12 years has led to more patients receiving treatment in private settings? Does the Secretary of State know how much money is given to private mental health providers? Do the Government honestly think they are getting good value for money?

Will Quince: This is not my direct area of responsibility, but of course mental health does present challenges for A&Es and for hospitals more generally. We are investing an extra £2.3 billion every year in mental health, we have 16% more staff and we have an additional bursary  to attract more nurses into mental health. But we do recognise the challenges, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield) is working hard to address them.

Neurological Diagnosis and Treatment: Waiting Times

Stephanie Peacock: What recent steps his Department has taken to reduce waiting times for neurological diagnosis and treatment.

Maria Caulfield: Reducing waiting times for diagnostics and treatment is a priority for this Government. The delivery plan for tackling the elective backlog sets out steps to recover and transform out-patient services across all specialisms, including neurology.

Stephanie Peacock: In March 2021, my constituent suffered a severe head injury. By the time they have their first neurology appointment in January 2023, they will have waited nearly two years for treatment. In the meantime, they have been unable to work, been rejected for disability benefits and are in severe pain. Does the Minister accept that this wait is unacceptable, and will she outline what support the Department is making available for those who are suffering while they wait for vital appointments?

Maria Caulfield: I thank the hon. Lady. I know she raised her constituent’s case in a Westminster Hall debate on 22 November and my understanding is that they now have an appointment for January, but there is absolutely a backlog from covid patients. We know that. That is why we are putting in over £8 billion in the next three years to deal with that backlog. That is in addition to the £2 billion we have already provided through the elective recovery fund. We have already virtually eliminated the two-year wait and we are now on track, by April, to eliminate waits of 18 months or more.

Social Care Workforce

Andrew Lewer: What steps his Department is taking to increase the size of the social care workforce.

Helen Whately: I thank all those who work in social care for what they do day in, day out for people whose lives depend on care. We are supporting care homes and agencies in their efforts to recruit staff, including with a substantial national recruitment campaign. In fact, colleagues may have seen some of the adverts while watching popular programmes such as “I’m a Celebrity”. We have also added social care workers to the shortage occupation list, so that social care can benefit from international recruitment to increase the workforce in the short term.

Andrew Lewer: A recent report from the Motor Neurone Disease Association, outlined at the all-party group on motor neurone disease, which I chair, found that most unpaid MND carers provide more than 75 hours of care a week, but many are unable to access respite services due to the lack of adequately skilled care  workers equipped to care for the complexity of MND sufferers’ needs. Will the Minister commit to increasing specialised training for conditions such as MND in the social care workforce to protect carers’ health and wellbeing?

Helen Whately: My hon. Friend makes an important point. I, too, have heard from family carers about the difficulties that they have faced in getting skilled professional help, which, in turn, gives them support and respite. At the moment, we provide £11 million annually for a workforce development fund, which social care employers can access to help to pay for staff training. Looking ahead, we are working on social care workforce reforms, of which training and skills will form a substantial part. I commit to looking into his suggestion that specialist training for MND care should be part of that.

Tim Farron: In the lakes, we have a problem with social care: although the people working in the care industry are phenomenal, talented and dedicated, the average age of the population is 10 years above the national average, so the number of people who need to be cared for is greater and the size of the workforce is smaller. Undoubtedly, poor pay, poor conditions and a lack of career prospects are a major problem in recruiting and retaining the care staff that we need. We also have a special problem in our area because of the absence, or indeed, the evaporation, of the long-term private rented sector, which is where the carers normally would have lived. Will the Minister talk to her colleagues in the Department for Levelling Up, Housing and Communities to make sure that we have a comprehensive package for communities such as mine in Cumbria, so that we have well-paid carers and places in which they can afford to live?

Helen Whately: The hon. Member makes a really important point. I will say two things. In the short term, we are supporting social care with £500 million through the discharge fund this winter. That will go into increasing capacity in social care and addressing some workforce challenges in areas such as his. In the long term, we are introducing social care reforms, including in the workforce. One thing we need to look at is ensuring that housing is available for the social care workforce.

Peter Bone: I have listened to the Minister talk about increased social care, but I do not recognise that in my area. Northampton General Hospital, which is one of the hospitals that serves my constituency, has around 150 patients who could medically be discharged but cannot be. That accounts for 19% of the beds. At the same time, West Northamptonshire Council is closing Spinneyfields, a 51-bed step-down facility in my constituency, yet it has a private finance initiative contract and, for the next seven years, will pay £700,000 for an empty building. How can that be right? Will the Minister sort it out?

Helen Whately: I will take away that example from my hon. Friend’s constituency and look into it. I want to see increased capacity in step-down care and social care during this winter and beyond, but particularly during this winter, supported by the £500 million discharge fund. That will go to areas such as his and across the country to help to make sure that people who do not need to be in hospital can be out of it getting the care that they need.

Barry Sheerman: When will the new Health team wake up to the fact that many of the things that we have discussed this morning—but particularly social care—will be solved only by treating local authorities as friends, allies and partners, rather than the enemy? Please can we have action to make local authorities full partners in delivering every sort of care?

Helen Whately: After hearing the hon. Member’s point, I should think that he therefore welcomes the fact that we have set up integrated care systems, which bring together health and social care. The £500 million discharge fund that I have mentioned is allocated to local areas to be pooled into the better care fund and spent jointly between local authorities and the NHS. Funding is an important part of this. In the autumn statement, social care received a historic funding settlement of £7.5 billion over the next two years. That is important, as well as ensuring that the NHS and local authorities work together hand in hand.

10-Year Cancer Plan

Jim Shannon: When his Department will publish the 10-year cancer plan.

Maria Caulfield: Earlier this year, we held a successful call for evidence on a new cancer plan, which received 5,000 responses. We are now considering those responses and how we can best support the diagnosis and treatment of cancer patients. I will be in a position to update the House shortly.

Jim Shannon: I thank the Minister for her response, but it has been five months since July, when the 10-year cancer plan was due to be published, and 10 months since February, when the war on cancer was announced. While the Government have delayed, cancer patients have faced unacceptable waiting times for diagnosis and treatment. Performance over the past five months has been the worst on record against the target of a 62-day wait between the GP referral for suspected cancer and the first treatment. I ask the Minister respectfully: does she agree that we in this House and the people of this country now need a long-term, ambitious plan to reduce waits and ensure that cancer patients in this country have the best outcomes possible? Will she set out a timeline—not just say “shortly”—for delivering such  a plan?

Maria Caulfield: As the hon. Gentleman knows, I cannot comment on what is happening in Northern Ireland, because health is a devolved matter. I can only update him on what is happening in England. We are not waiting for a cancer plan to start on the backlogs: that is why this Government are investing £8 billion over three years to clear the elective backlog. We are seeing record numbers of patients. Cancer treatments continued throughout the pandemic, but we are seeing a higher number coming through than usual. Despite the increase of more than 129% in patients getting urgent GP referrals since September 2019, 91% of patients in England are receiving their treatment within 31 days of the decision to treat, compared with just 87% of patients in Northern Ireland in June. We are very committed  to reducing cancer waiting times. I suggest that the hon. Gentleman may wish to speak to the Minister in Northern Ireland as well.

Maggie Throup: Diagnostic activity, whether in vivo or in vitro, forms part of more than 85% of clinical pathways. Will my hon. Friend confirm that it will receive due recognition in the 10-year cancer strategy?

Maria Caulfield: May I thank my hon. Friend for all her hard work during her time as a Health Minister? We are going through the responses to the call for evidence right now; as I have indicated, we will update the House shortly. I will very much take her points on board.

Meg Hillier: My constituent Jesse, who is 24, was diagnosed with grade 4 glioblastoma multiforme, a type of brain cancer. It has been devastating to her. She has had a very difficult year of treatment; crucially, after her initial round of treatment, there were delays in accessing a scan because of the backlogs in the NHS. There is a real need for a proper cancer care plan to make sure that she gets her scans as regularly as necessary. Other patients need them as well, but her scan was two months later than it should have been under the standard of care, leaving her in absolute terror that her cancer would come back. The fear is almost as bad as the disease itself. What plans does the Minister have to make sure that the 10-year cancer plan really gets to grips to the backlog, which is devastating people’s lives?

Maria Caulfield: I am sorry to hear about the experience of the hon. Lady’s constituent. I am sure that she will welcome the 91 community diagnostic centres that have already been set up to provide a range of tests, including CTs, ultrasounds and MRIs. We are expecting to deliver up to 160 community diagnostic centres in total, with the capacity for up to 9 million more scans per year when they are fully operational. That will not just deal with the backlog, but future-proof our diagnostic services.

Caroline Dinenage: The Minister will know that cancer is the biggest cause of death in children under 14. There are countless instances of failure and missed opportunity in how we detect it, how we treat it and how we care for children with cancer. I am grateful to her for meeting my constituent Charlotte Fairall earlier this year, who tragically lost her daughter Sophie. Does the Minister agree that we need a childhood cancer mission embedded in the heart of any cancer strategy if we are serious about saving other families from that tragedy?

Maria Caulfield: I thank my hon. Friend for all her hard work in this space and for leading our debate on childhood cancer outcomes in this Chamber. I was delighted to meet her constituent Charlotte, who is campaigning so hard on the issue. I promised her that we would look at a child cancer mission; we will update the House on our progress shortly.

GP Recruitment

Ruth Cadbury: What progress his Department has made on its commitment to recruit 6,000 additional GPs by 2024.

Steve Barclay: In September 2022 there were nearly 2,300 more full-time equivalent doctors in general practice than there were at the same time in 2019, and more than 9,000 GP trainees.

Ruth Cadbury: A constituent of mine, a full-time GP in her 50s, told me that the pension rules mean she has to retire, work part-time or emigrate, which is hardly likely to help her patients to obtain appointments with her. Having hinted at a change in doctors’ pension rules last summer, the Government are only now announcing a consultation that will last until next spring, so there will be no change in these crazy rules until next summer at the earliest. Is this not too little, too late?

Steve Barclay: It is worth reminding the House that there are 3% more doctors this year than last year. As I have said, we have 2,300 more full-time GPs, and we are recruiting more. However, the hon. Lady is absolutely right about doctors’ pensions; that is a material issue, which is why we launched the consultation, and we are working with Treasury colleagues to address these concerns as quickly as possible.

Virginia Crosbie: GP numbers are falling in Wales. Healthcare is devolved to the Welsh Labour Government, and although Ynys Môn is represented by five members of the Senedd in Cardiff, healthcare concerns constitute a staggering 25% of my postbag. Does the Secretary of State agree that families throughout Wales are not receiving the healthcare that they need and deserve from the Welsh Labour Government?

Steve Barclay: I do agree with my hon. Friend, and I think it would help the House to assess the performance of the Welsh Government if there were more transparency. For instance, the Opposition motion on today’s Order Paper refers to vacancies in England. I am sure it will surprise the House to learn that the Welsh Government stopped collecting statistics for workforce vacancies in 2011. I look forward to Opposition Members’ encouraging their Welsh colleagues to be more transparent.

Lindsay Hoyle: I call the shadow Minister.

Feryal Clark: Members on both sides of the House will have been shocked and appalled by the recent deaths of children from streptococcus A, and our thoughts are with all the families affected. Cases are on the rise, and as we head into winter it is vital for parents to be able to secure for their children the care that they so desperately need. The shortage of GPs means that too many are struggling to see a doctor, and now there are reports of shortages of antibiotics as well. What advice can the Secretary of State give parents whose children are exhibiting symptoms but who cannot obtain a GP appointment, and what assurances can he give on the supply and availability of antibiotics?

Steve Barclay: This is an important issue which I know is of concern to many families throughout the country, so I am pleased to be able to reassure the House about our response. While GPs are important in this regard, so are directors of public health, who are leading the response in respect of, for example, liaison with schools. We are seeing a peak in cases earlier than  usual, which we believe is due to lower exposure during the pandemic, which in turn has led to lower immunity. There is no new strain, and that is one of the key points of reassurance, but the UK Health Security Agency has declared a national standard to improve the co-ordination of our response, including what is being done in schools.

Hospitals: New Builds and Upgrades

Elliot Colburn: What steps he is taking to upgrade existing hospitals and build new hospitals.

Steve Barclay: As we heard earlier, the Government are committed to a programme to create 40 new hospitals by 2030. We have committed £3.7 billion—[Interruption.] The hon. Member for Ilford North (Wes Streeting) will get a go in a moment, and I look forward to hearing him welcome the increase in the Government’s capital spending, not just on our new hospitals programme but on, for instance, elective surgery. We are putting £5.6 billion into more surgical hubs and community diagnostic centres, and £1.7 billion has gone to more than 70 hospitals to enable them to deliver significant upgrades.

Elliot Colburn: Patients in Carshalton and Wallington will benefit massively from the building of a new hospital in Sutton and the improvement of St Helier Hospital under NHS plans approved by the Government. Will my right hon. Friend agree to meet me, and the NHS trusts? They are raring to go and to get spades in the ground next year.

Steve Barclay: I know they are raring to go because I personally have spoken to the chief exec about this scheme, but I can offer my hon. Friend something better: the Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince), will personally be visiting shortly to discuss this further. But I also need to be transparent with the House: we are fundamentally changing how we are going to be building hospitals in the NHS estate—[Laughter.] I am not sure why something as important as new hospitals—learning from the Department for Education and the Ministry of Justice through a more standardised model that allows us to deliver more at a cheaper unit price and get them built quicker—is a source of mirth to Opposition Members. It is important that we standardise those designs, and that is what my colleague the Minister of State will be discussing with my hon. Friend.

Hilary Benn: The new children’s hospital, the new adult building and the maternity centre at Leeds General Infirmary will bring much-needed new facilities to Leeds and the region, as well as wider economic benefits. It is unusual among the hospital building schemes. As the Secretary of State knows, the site is clear and the plans are ready, so may I urge him to give the go-ahead as soon as possible?

Steve Barclay: I visited that scheme over the summer. The right hon. Gentleman will know that the costs have inflated significantly since what was signed off by the Treasury in 2019. I think the point that has been missed by Opposition Members is that the way we deliver these  schemes is to grip the cost better by using standardisation, and that is what I will be discussing with Leeds General. I agree with him that it is important that the scheme goes ahead, and we need to work together to make sure that it does so at a price that is affordable.

NHS Dental Contract

Scott Benton: What progress he is making on negotiating a new NHS dental contract.

Neil O'Brien: In July, we made some initial changes to the reformed system to support NHS dentistry. We have invested an extra £50 million, reformed the contract to create more UDA—unit of dental activity—bands to better reflect the fair cost of work, and introduced a minimum UDA to help practices where the levels are low, allowing dentists to deliver 110% of their UDAs to provide more treatment. The number of dentists doing NHS work last year was up 2.3% but we are working on plans to go further.

Scott Benton: The changes made to the dental contract last week were a step in the right direction, but they fall some way short of the holistic reform required to help the estimated 25,000 of my constituents who do not yet have an NHS dentist. Will the Minister consider a change whereby the NHS funds subsidies to underprivileged areas such as Blackpool, thereby allowing NHS practice to offer a greater financial incentive to attract new dentists into those areas?

Neil O'Brien: Absolutely; my hon. Friend and I have talked about this. We are looking urgently at payment models and measures to address areas that are struggling to attract the right workforce. The commissioning of dentistry will be coming down to a more accountable local level in April, and we need to build on that.

Mary Foy: My constituents in Durham have told me tales of DIY dentistry, missing teeth, children in pain and the unfairness of only being able to access dental care if they can afford it. Things should not be this way. The British Dental Association does not accept that the Government’s new plans go far enough to halt the decay in NHS dentistry provision. Will the Minister tell me when the Government will put in adequate funding and reform so that people in Durham can get the dental care that they need and deserve?

Neil O'Brien: As well as increasing the number of dentists doing NHS work and the amount of work being done, we are taking further steps to look to the longer term and build NHS dentistry. The number of dental school places is up from 810 in 2019 to 970 in 2021, but of course we want to go further. We are making it easier for dentists to come to the UK to practise. In fact, we laid draft secondary legislation on 11 October to give the General Dental Council more flexibility to do that. Around the country, plans are advancing for centres for dental development to provide not only additional dentists but hygienists and other nurses.

Health Inequalities

Peter Gibson: What plans he has to reduce health inequalities.

Mary Robinson: What plans he has to reduce health inequalities.

Neil O'Brien: We are taking action on public health across the board. The £3 billion that we are investing in the drugs strategy will create an extra 50,000 places in drug treatment. We have doubled the duty on cigarettes since 2010 and brought in a minimum excise tax. We now have the lowest smoking rate on record and will go further. The £300 million that we are investing in Start for Life means new or expanded family hubs in 75 local authorities. We are taking action right across Government, from the £55 billion that we are investing in energy support to the measures that we are taking through at the moment to crack down on non-decent housing.

Peter Gibson: Levelling up is not just about jobs and infrastructure; it is about healthcare too, and dentistry is a key part of that. However, Darlington faces the potential closure of its surgery, which serves 7,000 patients, because the current system of NHS dentistry makes the business case for that surgery unviable. What will my hon. Friend do to ensure that we level up dental services so that my constituents can get the services that they need?

Neil O'Brien: My hon. Friend and I have discussed this, and we are due to meet again shortly. I repeat my offer to speak both to that practice and to local partners so that we can tackle this crucial problem.

Mary Robinson: Research by the University of Manchester adds to the significant body of evidence showing that addressing disparities in healthcare is key to levelling up. Inequalities have resulted in a 30% productivity gap in the north, which can be attributed to poorer health. Will my hon. Friend outline how the Government are working to address this and to ensure that residents of the north are not at a health and care disadvantage?

Neil O'Brien: I saw that important report, and we have to tackle the problem from both the health end and the economic end. Spending on health in the north grew from £36.5 billion in 2018-19 to £52.6 billion in 2020, so there is significant investment in health and preventing ill health in the north. Economic activity stops people sliding into a cycle of ill health and worklessness, and we are working jointly with the Department for Work and Pensions to roll out more disability employment advisers in jobcentres. The underlying key is to tackle and prevent ill health, hence the £3 billion drug strategy and the measures on smoking, energy and housing.

Jamie Stone: I will give the Minister a good example of health inequality. Until quite recently, we had a perfectly good consultant-led maternity service based in Caithness. Following the Scottish Government’s rubber-stamping  decisions, pregnant mothers now have to make a 200-mile return journey to Inverness to give birth. That glaring inequality is despicable. I hope His Majesty’s Government will share best practice with the Scottish Government on tackling this problem.

Neil O'Brien: I am always keen to work constructively with the Scottish Government. This sounds like a serious problem. My right hon. Friend the Secretary of State set out how we are using our health and capital spend more efficiently, and unfortunately this is an example of where it is not happening in Caithness.

Helen Morgan: It is well documented that people in rural areas have worse health outcomes than people in urban areas. One driver is that the most vulnerable people lack access to the services they need. Will the Minister consider working with his colleagues in the Department for Transport to figure out how the most vulnerable people can access the healthcare they need?

Neil O'Brien: We are rolling out community diagnostic centres to bring services closer to those who need them, and we are investing in 21,200 extra people working in general practice to make sure that rural services, as well as services in the rest of the country, are improved.

Lindsay Hoyle: I call the shadow Minister.

Andrew Gwynne: In 2019, the Tories promised to extend healthy life expectancy by five years, but on this they are failing. In the last year, the health disparities White Paper has disappeared, the tobacco control plan has been delayed and they have chickened out on implementing the obesity strategy because the Prime Minister is too cowardly to stand up to his Back Benchers. Health inequalities are widening as a consequence. Does the Minister plan to revive any of these strategies, or have the Conservatives completely given up on prevention?

Neil O'Brien: I have already talked about some of the things we are doing to crack on with improving public health and narrowing inequalities, but I will add some more. We are driving up blood donations from shortage groups and vaccine uptake in areas with the lowest uptake. I mentioned the extra £900 million for drug treatment, taking the total to £3 billion over three years. I will not repeat all the things I mentioned but, across the board, we are working at pace to improve public health and narrow health inequalities.

Sudden Cardiac Arrest

Margaret Ferrier: What steps his Department is taking to improve survival rates from sudden cardiac arrest.

Helen Whately: Immediate cardiopulmonary resuscitation doubles or quadruples the chance of surviving an out-of-hospital cardiac arrest. Defibrillation within three to five minutes dramatically improves the chance of survival, which is why NHS England is establishing a network of defibrillators and community first responders to save up to 4,000 lives a year by 2028.

Margaret Ferrier: On average, 150 people a day die from sudden cardiac arrest outside hospital. Access to a defibrillator is crucial for survival. Without one, the chance of surviving drops by 10% every minute. I welcome the Government’s commitment to rolling out defibrillators across state-funded schools in England and Wales, but I share the concern that, because of significant ongoing supply chain issues, it might not be achieved. Can the Minister explain how the Department is helping to reach the target of supplying 20,000 defibrillators by 2023?

Helen Whately: As the hon. Lady says, access to a defibrillator makes a great difference to the survival prospects of somebody having a sudden cardiac arrest, which most commonly happens either at home or in the workplace. Since May 2020, the Government have required all new school builds and refurbishments to have defibrillators installed. I am happy to look into the concern she raises and get back to her. I am also working on other initiatives to make sure we get more defibrillators into public places.

Edward Leigh: Like many of my Lincolnshire constituents, I live in a remote village and in the unlikely event of my having a sudden cardiac arrest—I am sure that would disappoint people—there is no prospect of an ambulance coming within 10, 15 or even 20 minutes. The Government could make themselves really popular in rural areas by having a massive campaign to roll out defibrillators in most villages. For instance, we have a good opportunity to put a defibrillator in all those red telephone boxes that BT are now closing down.

Helen Whately: My right hon. Friend makes an important point, and this is exactly why work is going on to increase the number of defibrillators across the community, for instance, in villages such as his. Many villages will already have them. We are also supporting the NHS to train community first responders to make sure that there are people all across the community who have the skills to do CPR— cardiopulmonary resuscitation—and use a defibrillator. I look forward to being able to announce shortly a new initiative that will mean further defibrillators across our communities.

Social Care Reform

Catherine West: What progress he has made on delivering social care reform.

Helen Whately: We are already putting social care reforms into practice. For instance, we want care providers to adopt digital care records, and more than 50% have already done so. I am determined to shine more light on our social care system, so our new Care Quality Commission-led assurance of local authorities’ social care duties will start in April.

Catherine West: One of the worst vacancy rates across the NHS is that of geriatricians. What urgent action is the Minister putting in place to ensure that people either at home with domiciliary care or in social care settings are seeing a geriatrician consultant regularly? If there is a shortage, which I believe there is, what action is she taking to have more doctors train as geriatricians?

Helen Whately: The hon. Lady makes an important point about people who are receiving social care also having access to the healthcare they need and these systems working together across our health and social care systems. We are training more doctors overall, and we have an increase in medical school places, which is leading to more doctors coming through. I am happy to take away and look at her question about the number of geriatricians.

Wendy Morton: On delivering social care reform, does the Minister agree that we also need to be looking at how the funding packages work, particularly across borders? I have a constituent whose case falls between two local authorities. Will she agree to meet me as a matter of urgency to make sure that this poor constituent receives the funding she needs for her husband’s care?

Helen Whately: As announced in the autumn statement, we have a record funding settlement of £7.5 billion going into the social care system over the next two years, to improve both access and quality of care. I am happy to meet my right hon. Friend to look into the specific challenge that she has outlined, because it is important that local areas are working together across boundaries.

Lindsay Hoyle: I call the shadow Minister.

Liz Kendall: Let’s just tell it like it is on the Government’s record on social care reform. Their cap on care costs was first promised 10 years ago. In 2015, they delayed it and in 2017 they scrapped it. In 2019, the right hon. Member for Uxbridge and South Ruislip (Boris Johnson) again promised to fix the crisis in social care, but last month the Chancellor buried the policy, once and for all. After 12 long years, what have Conservative Members got to show on social care: the highest ever staff vacancies; millions left without the care they need; hospitals full of people who do not need to be there; and families picking up the strain. Isn’t the truth on social care, just as with our economy, transport, housing and schools, that the Conservatives have run out of excuses and run out of road, and the country deserves a change?

Helen Whately: We have delayed our social care charging reforms because we listened to those in the system and we heard local authorities asking for more time to prepare. Importantly, we have allowed local authorities to keep the money allocated to that in their bank accounts to fund some of the current pressures on social care. I ask the hon. Lady to recognise the record funding settlement for social care in the autumn statement—£7.5 billion for social care over the next two years—which she has not even acknowledged. That is coupled with the fact that we are pressing full steam ahead with our system-wide reforms to social care, with funding of more than £1 billion to support the workforce and innovations in social care and to transform the quality and access to social care across the country.

New Hospitals Programme: King’s Lynn

James Wild: What recent assessment he has made of the expressions of interest submitted by Queen Elizabeth Hospital King’s Lynn NHS Foundation Trust to be part of the new hospitals programme.

Steve Barclay: I had the question down as No.13, but given who is asking the question I can guess that it is related to the build of the King’s Lynn hospital.
I visited the site and looked at the scheme over the summer. I made it clear in a speech that I gave to NHS Providers that addressing the concerns of the RAAC—the rebar autoclaved aerated concrete——hospitals is my No. 1 priority. Obviously, I cannot comment on individual schemes while the process is ongoing, but I can assure my hon. Friend that we are working actively on it.

James Wild: I warmly welcome the priority that my right hon. Friend has put on resolving the serious RAAC concrete issues at the Queen Elizabeth Hospital, but the decision on this was due in the spring. Christmas is coming and the only question that people in North West Norfolk have is, when will we get the present that everyone wants—a new hospital for the staff and patients?

Steve Barclay: I note the extensive support that my hon. Friend has among parliamentary colleagues, including my right hon. Friend the Member for South West Norfolk (Elizabeth Truss), who has recently added her support to the scheme. He will be aware that we allocated £20 million last year and £30 million this year to address some of the immediate issues, but we recognise that it is a priority and we are working on it.

NHS Dentists

Greg Knight: What recent steps his Department has taken to increase the number of dentists working in the NHS.

Neil O'Brien: As well as making it more attractive to practise in the NHS, the number of dental school places is up from 810 in 2019 to 970 in 2021, making it easier for qualified dentists to come to the UK. We are putting through secondary legislation on that and encouraging new centres for dental development.

Greg Knight: Is the Minister aware that there is a particular problem in Bridlington in my constituency, where an increasing number of residents are finding it not just difficult to access NHS dental care, but impossible to do so? Recently, a dental practice in the town has closed. Will he agree to meet me on this matter to see what can be done to resolve the issue, hopefully sooner rather than later?

Neil O'Brien: Of course, I would be keen to meet to try to address those issues and to build on the work that we are doing nationally.

Rachael Maskell: York has had a dental desert for years. It is six years now to see an NHS dentist and the Government have made no change to improve that situation, or to bring more NHS centres into my area. In March, dentistry will be moving into integrated care systems and integrated care boards. How are they going to solve the problem?

Neil O'Brien: One problem has been that having large, remote regional commissioning for dentistry has meant that it is more unlikely that specific local problems will be picked up. That is why we are taking the step that  the hon. Member has described. She is now complaining about it, even though it is a measure to get more local accountability over the way that services are commissioned.

Medical Students: University Places

Michael Fabricant: What recent discussions he has had with the Secretary of State for Education on increasing the number of university places for medical students; and if he will make a statement.

Will Quince: The Department has commissioned NHS England to develop a long-term workforce plan. That plan will help to ensure that we have the right numbers of staff, including doctors with the right skills, to deliver high-quality services fit for the future. The plan will be independently verified. We have funded 1,500 more medical school places in England and opened five new medical schools in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury, and there are record numbers of medical students in training.

Michael Fabricant: I thank my hon. Friend for his answer. He will know that it takes five or six gruelling years to get a Bachelor of Medicine or a Bachelor of Surgery degree—or Doctor of Medicine in Scotland—but many students, having graduated, think that they would prefer more structured development by working as hospital doctors. What can we do to encourage young graduates to go into general practice?

Will Quince: We have record numbers going into general practice, which is the remit of the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien), but part of the plan is to make it more attractive through practice improvement through cloud-based telephony, the additional roles reimbursement scheme, the 24,000 extra staff in primary care, developing multi-function staff so that people can develop their skills and have specialism but still practise as a GP, increasing the use of pharmacy, moving towards more continuity of care and the new GP contract for 2024-25.

Chris Bryant: But when are we going to see the workforce plan? The other day I spoke to a radiologist who runs a radiology department. There are meant to be 15, but there are only five and they have not had a single person apply. It needs more radiologists and radiographers. We have a national shortage of dermatologists, which is one reason why skin cancers are not being picked up, and a national shortage of pathologists and histopathologists. We need a dramatic increase in the number of people working in the NHS. When are we going to see that workforce plan?

Will Quince: As I said, we have committed to publishing a comprehensive workforce strategy, which, as the Chancellor set out, will be independently verified. That will come soon. We have also set out new pension flexibilities. However, it is important to point out that we have 29,000 more nurses and we are on track to meet our 50,000 target. We have 3,700 more doctors compared with last year, 9,100 extra nurses and 2,300 more GPs.

Topical Questions

Helen Hayes: If he will make a statement on his departmental responsibilities.

Steve Barclay: We know that women can benefit from more personalised care, especially in pregnancy. The Tommy’s app is a new clinical decision tool for the NHS and for women, another example of how we are using artificial intelligence to improve our maternity system. That will help to end some of the variation in maternity care from hospital to hospital. I am pleased to tell hon. Members, particularly my hon. Friend the Member for Rutland and Melton (Alicia Kearns), who is a great champion of improved mental health, that today my Department, through our National Institute for Health and Care Research, has agreed to provide the funding needed for the next stage of the app’s development. I pay tribute to Sienna and all those other babies born stillborn to their parents and thank all those in this Chamber who have campaigned passionately on this important issue.

Helen Hayes: Another dental practice in my constituency recently handed back its NHS contract. When I contacted local NHS management about the impact of the closure, it stated that the area in question was adjudged to be well served for NHS dentistry practices because there are 11 practices within a half-mile radius. The experience of my constituents, now left searching for NHS dental services, is that none of those practices is accepting new NHS patients. What is the Secretary of State doing to ensure that assessments of the sufficiency of NHS dental services reflect the real situation on the ground, and when will we see a sustainable solution to the problems my constituents face?

Steve Barclay: The hon. Lady raises an important issue that is of concern across the House, as we have already seen in the exchanges the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) answered. That in part was why, during the pandemic, we used £1.7 billion of funding to protect dentistry and why we got a commitment through the £3 billion a year funding of dentistry, but we are looking at how we localise that commissioning to get better value out of the contract, which was the point my hon. Friend raised.

Mary Robinson: At 1 o’clock today, patient safety expert Dr Bill Kirkup will be speaking to MPs at the all-party parliamentary group for whistleblowing, to which all colleagues are invited. It is a timely meeting following last week’s “Newsnight” programme, which highlighted yet another NHS trust where a culture of fear left staff unable to speak up on patient safety concerns. It is clear change is needed. Does my hon. Friend agree that supporting whistleblowers in the NHS is crucial to patient safety?

Neil O'Brien: My hon. Friend is so right. I praise her work with the APPG and I know many colleagues will want to attend. Whistleblowers  can save lives and improve healthcare, as I have seen in my own constituency, and she is right to be pressing on this matter.

Lindsay Hoyle: I call the shadow Secretary of State.

Wes Streeting: The chairman of the Conservative party claims that NHS strikes are exactly what Vladimir Putin wants, so why is not the Health Secretary negotiating to prevent them from going ahead?

Steve Barclay: I have seen the hon. Gentleman make that claim across the media a number of times. Just to reassure him, my door is open and I have been clear with the trade unions that I am available; I am available to them this afternoon or tomorrow. It is not I who set a precondition for those talks. When I met the trade unions, they raised a number of issues; not only pay, but safety of staff and other conditions, the estate, tech and so forth, and I am happy to engage with them on those points.

Wes Streeting: We get the warm words about wanting to negotiate, but a Government source briefed The Times last week that the Secretary of State’s plan is to wait for public sentiment to turn against striking nurses, saying:
“This is going to affect a lot of people…it could have a big impact on a lot of them and…in the end they will get fed up”.
He knows that this winter is going to be the most difficult that the NHS has ever faced, and he is using nurses as scapegoats to avoid the blame. That is the shameful truth, isn’t it?

Steve Barclay: First, it is a bit bizarre that, at departmental questions, the best the hon. Gentleman can manage is “a Government source”. Secondly, the revelation from that Government source is that this will affect “a lot of people”. I do not think that comes as any surprise. That is why we regret the action and are very open to having talks. The point is that he himself does not support the 19% pay demand of the trade unions. He stands here saying that we should be talking while he himself does not accept their proposal.

Bob Blackman: There have been several changes of Ministers, as we know, but officials have carried on working through these changes, so can we know on what day, date and time the long-promised and overdue tobacco control plan will finally be published?

Neil O'Brien: Whatever format our next steps forward are set out in, we will be pushing forward very quickly and aggressively on this. This year, we are putting £35 million into the NHS to support our services for everyone who goes in to stop smoking. We have doubled duty on cigarettes and brought in a minimum excise tax. Women who are pregnant now routinely get a carbon monoxide test. National campaigns such as Stoptober have now helped 2.1 million people to quit smoking. We are also supporting a future medically licensed vaping product as a quitting aid. We will be pressing forward at the greatest speed.

Lindsay Hoyle: I call the SNP spokesperson.

Steven Bonnar: Intellectual property protections are an important way of protecting healthcare companies’ innovations, as we know. However, developments on intellectual property can also impact the rights of individuals, limiting access to affordable, life-saving and essential medical products. What recent representations has the Secretary of State made to colleagues in the Department for International Trade to seek assurances that nothing in the proposed free trade agreement with India will impact or jeopardise access to affordable medicines for NHS patients in Scotland?

Steve Barclay: I can reassure the hon. Gentleman on that. I would have thought that he would also welcome the commitment to a £15 billion to £20 billion increase in R&D investment, the championing of life sciences that the Minister for Health, my hon. Friend the Member for Colchester (Will Quince), has been leading on, and the opportunity we have to address greater variation within the NHS by bringing forward the innovations from our life industry and applying them much more quickly.

Alexander Stafford: Several GP practices in Rother Valley, such as Swallownest Health Centre, operate a policy of having to ring the doctor’s surgery at 8 am for an appointment. Residents find themselves being placed 50th or 60th in the queue, and are then told that no appointment is available and to call back the next day. This is clearly an unacceptable way to offer appointments. What steps are my hon. Friends taking to stop the current failed booking system and instead guarantee a system of pre-booked appointments at all GP surgeries?

Neil O'Brien: That is something that we are working on very actively. As well as financially supporting GPs to roll out new and better ways of managing their appointments, we are looking at what criteria we expect from GPs. We already set out some moves in our summer action plan, but we will be looking further at preventing the lamentable situation my hon. Friend describes of people being asked to ring back or being held in long phone queues. That is not acceptable.

Karl Turner: The public are not daft. They know that the backlogs in the NHS existed well before the pandemic, they know that the NHS was already on its knees, and they know that it was this Tory Government who brought it to its knees. So why do the Government not take up Labour’s policy of scrapping non-dom status, use the £3.6 billion to train nurses, doctors and midwives, and get the NHS back on its feet? People in east Hull want nurses, not non-doms.

Steve Barclay: The data is very clear; in fact, it is very stark on the extent to which the backlog is driven predominantly by the pandemic. That is why we have a programme, through the extra investment in the autumn statement: the £6.6 billion over the next two years going into the NHS, but also the £2.8 billion next year and £4.7 billion the year after into social care, and £8 billion in 2024. We recognise the size of those backlogs, so we can fund the surgical hubs and diagnostic centres.

Sheryll Murray: I met local care providers last Friday, and they raised two main points with me: concerns about energy costs and covid in care homes. They were keen to see their nursing staff vaccinated with residents, all at the same time. I recognise that that happens in some places, but can we look at making it the norm throughout the country?

Helen Whately: My hon. Friend makes an important point. The NHS is strongly encouraging local vaccination teams to vaccinate staff, as well as residents when they visit care homes. That should be normal practice. I am happy to look into it, if that is not happening in her area. I take this opportunity to encourage any health or social care worker who has not had their covid or flu jab this winter to please go ahead and get one.

Clive Efford: Parents are becoming increasingly worried about the current prevalence of strep A. It is a time of year when parents are going to have children with high temperatures and sore throats, so concern is likely to be very high. There are also concerns about the availability of antibiotics. Does the Secretary of State believe that this is a moment where the Government need to make a statement and show clear leadership to calm people down and reassure them about the situation?

Maria Caulfield: We held a cross-party briefing last night on strep A. We want to reassure parents, and if their children have symptoms and they are concerned, please seek help. GPs are ready and A&E departments are ready, and we have directors of public health proactively going into schools where there are cases. There is no shortage of antibiotics—we want to reassure people on that—and we are keeping an eye on that on a daily basis.

Antony Higginbotham: The East Lancashire community diagnosis centre already includes Burnley hospital, and as part of that we are opening two new endoscopy rooms in the spring. Residents, the trust and I know that the local hospital can do even more to reduce the covid backlog with the right Government investment. Will the Minister agree to meet me to discuss phase 9 of the hospital’s development, which would bring a brand-new radiology suite?

Will Quince: My hon. Friend is a strong champion for Burnley, and I congratulate Burnley General Teaching Hospital on the incredible innovative work it is doing. He is right that rolling out 91 out of 160 CDCs is a tremendous effort, but we want to go further, and I would be delighted to meet my hon. Friend to discuss these plans further.

Beth Winter: Last week, the First Minister of Wales, Mark Drakeford, said that pay awards are not being funded at the level they should be. The Wales TUC general secretary said that unless we have a fairer funding settlement for Wales, we are going to struggle going forward. When will this Government listen to the Welsh Government and the Welsh trade unions and provide the proper funded pay award that NHS staff deserve?

Steve Barclay: I simply direct the hon. Member to the Barnett consequentials. As a former Chief Secretary who has had those discussions with the Welsh Finance Minister I know, and the hon. Lady should know, that Wales gets significantly more funding per head of population than England. I hope she welcomes the fact that, through the extra £6.6 billion in the autumn statement, the First Minister will have a significant uplift, and it is for him to decide how he wishes to spend that money.

Gagan Mohindra: I was recently contacted by Amanda in my beautiful constituency of South West Hertfordshire, whose 88-year-old mother had fallen in her flat and unfortunately broken her hip. After waiting for five hours and making two calls to 999, her mother was still lying on the floor. Once they arrived at A&E, Amanda and her mother waited several more hours before being seen. Can my right hon. Friend assure the House that he is doing everything possible to find a solution to this system-wide issue?

Steve Barclay: My hon. Friend raises an extremely important case. I am happy to meet him to discuss it further, because it is a concerning case and I am keen to engage with him on it.

Mary Foy: My hon. Friend the Member for Denton and Reddish (Andrew Gwynne), the shadow Minister for public health, touched on health inequalities earlier, but I did not hear the Health Secretary recommit to publishing the White Paper by the deadline. Does he understand that the cost of living crisis and poverty are leading to greater health inequalities and that action is needed urgently? Can he recommit to that White Paper being published?

Steve Barclay: We are absolutely committed to addressing health inequalities. Rather than simply looking at 10 years’ time, we are looking at the immediate actions we can take, because what matters—[Interruption.] Those on the Opposition Front Bench chunter about White Papers, but what I am interested in is immediate delivery—what we can be doing now, rather than speculating about what is done in 10 years’ time.

Sajid Javid: We are seeing a sad increase in suicide rates across the country. In 2012, the then Government published a 10-year cross-Government suicide prevention plan. Earlier this year, the Government under the leadership of my right hon. Friend the Member for Uxbridge and South Ruislip (Boris Johnson) committed to a new 10-year plan that would be published before the start of 2023. There is no sign of that cross-Government 10-year suicide prevention plan, but maybe I am wrong, and perhaps the Government are about to publish it, because I know that so much of the work has already been done. May I ask my right hon. Friend the Secretary of State to show that he takes suicide prevention seriously and publish this plan as soon as possible?

Maria Caulfield: I thank my right hon. Friend and pay tribute to him for all his work in this area; he has driven this agenda forward. I want to reassure him that we are looking at that. He will understand that we have had some changes in recent weeks, but I assure him that tackling the issue of suicide is a high priority, and we will make an announcement shortly.

Rupa Huq: In a case that is sadly all too typical, a GP in Ealing, who has seen their patient list go up from 3,000 to 9,000 in the last decade, had plans approved for expansion, but NHS estates now will not cough up. What are the Government doing to support doctors in inadequate premises who cannot increase their patient lists to expand and modernise in the current climate?

Neil O'Brien: The total activity done by GPs was about 7% up in October compared with the previous year. We are actively looking at the way that capital works and the contributions of section 106 and the local integrated care board, to ensure that, as well as having those 2,300 extra doctors and 21,000 extra staff, GPs also have good facilities to work in.

Robert Courts: Access to dentistry is an acute issue for West Oxfordshire. Can Ministers explain what they are doing to help rural areas such as mine, and can we meet to discuss it further?

Neil O'Brien: I have mentioned the fact that the number of NHS dentists was up 2% to 2.3% last year, as well as the extra £50 million and the reforms we have made to the contract, but we will go further. We want to address those areas, and particularly rural areas, where more provision is urgently needed.

Patricia Gibson: The chair of the Royal College of General Practitioners has expressed concerns about patients with chronic conditions such as asthma, diabetes and even serious mental health conditions refusing sick notes because they cannot afford time off work. What discussions has the Secretary of State had with Cabinet colleagues about the adequacy of statutory sick pay during this cost of living crisis?

Steve Barclay: I refer the hon. Lady to the autumn statement, in which my right hon. Friend the Chancellor set out a wide range of support packages to help with the cost of living across the United Kingdom, including the cost of energy. That is part of wider discussions that we have on a regular basis with the Treasury.

Dr Caroline Johnson: The pandemic has had a devastating effect on the number of people waiting for treatment. In 2019, there were 54 women waiting more than a year to see a gynaecologist. That number is now more than 40,000. What is my right hon. Friend doing to reduce this wait?

Steve Barclay: This is a good illustration of the challenge the country faces with backlogs that are very much driven by the pandemic. We are working with senior figures such as Jim Mackey and Professor Tim Briggs and the Getting It Right First Time programme to look at patient pathways, how we use our diagnostics and our surgical hubs and streamlining the way we get services to patients where backlogs have built up.

Gavin Robinson: This morning, we tragically learned that a five-year-old girl who was a P2 pupil at Black Mountain Primary School died yesterday in Belfast with strep A. I am grateful to the Minister for the answer she gave to the hon. Member for Eltham (Clive Efford) on strep A and her encouraging commitment that antibiotics including penicillin are available, but  can she ensure that our public health agencies across this United Kingdom co-operate with one another and that if additional resource is required, it will be made available?

Maria Caulfield: I am very sorry to hear about that tragic case in Northern Ireland. We want to reassure people that, while there is a slightly higher number of cases than usual for this time of year, the UK Health Security Agency is on top of this and is not concerned that there is a wider outbreak than would be expected. We want to encourage parents who are concerned that their children are not responding to get help as soon as possible. Antibiotics are available, and local directors of public health should be co-ordinating local activity, but if there are any concerns, Members should come and see me.

Anna Firth: On Saturday, I visited Chalkwell Grange, a brilliant new care home in picturesque Leigh-on-Sea which is struggling to recruit due to the guidance that all care workers should wear face masks. Will the Secretary of State give care homes the best Christmas present ever and change the word “should” to “can” or “may”, to put them in charge of their own infection control?

Helen Whately: I thank my hon. Friend; it is good to hear that she has visited a local care home. I have also heard what she heard from staff. Although face masks are important for infection control, we know that they have downsides, such as making communication harder. I have asked for updated public health advice on the use of masks in care homes and I look forward to updating hon. Members and the social care sector on the guidance about that shortly.

Daisy Cooper: My constituent is a victim of sexual misconduct by a medical professional, but they cannot challenge that professional’s fitness to practice because of the five-year rule. The General Medical Council wants that rule to be scrapped and the Government consulted on whether to get rid of it more than a year ago. Can the Minister say whether it is the Government’s intention to scrap it? Will she meet me to discuss how important it is that the GMC can explore whether a potentially dangerous medical professional who is still practising may be unfit to do so?

Maria Caulfield: I thank the hon. Lady for her campaigning on this serious issue. I am happy to meet her and I suggest that we also meet the patient safety commissioner, Henrietta Hughes, to discuss it further.

Peter Bone: Can the Secretary of State give the House an undertaking that no NHS or social care facility will be decommissioned and used to house asylum seekers in Northamptonshire or the rest of the country?

Steve Barclay: I am not aware of any proposal on those lines. On my hon. Friend’s earlier point, as I said, I am happy to meet him to discuss the issue of step-down care and I am sure that there will be an opportunity to discuss any other concerns that he has at the same time.

Emma Lewell-Buck: My constituent Margaret Cramman is a full-time carer for her daughter. Throughout the pandemic, she was denied respite care. Now the care setting insists on testing for visitors and mask wearing for staff, which causes distress to some of the young people being cared for, who rely on vital facial recognition. Nearly all the other covid guidance has been reviewed, but the guidance for respite care remains the same. Why are carers and those they care for always an afterthought for the Government?

Helen Whately: I point the hon. Member to the answer that I gave to my hon. Friend the Member for Southend West (Anna Firth) a moment ago specifically about face masks. I have asked for updated guidance for the social care sector on the use of face masks. I recognise the difficulties they cause—for instance, in communication—and I am looking forward to being able to give an update to hon. Members and the sector on that shortly.

Lindsay Hoyle: Last question, Margaret Ferrier.

Margaret Ferrier: What assessment has the Secretary of State made of geographic variation in access to innovative liver cancer treatments, such as selective internal radiation therapy?

Steve Barclay: It is a brilliant question on which to close, because one of the things that all hon. Members should be hugely interested in is how we are adopting innovation more quickly and industrialising that innovation across the NHS as a whole, as opposed to in silos. That is something that we are focused on in the Department and it is a key priority. I am happy to speak to the Scottish Government and others about how we can work together on that.

Point of Order

Gregory Campbell: On a point of order, Mr Speaker. During last week’s debate on Northern Ireland and the reduction of pay for Members of the Legislative Assembly, I raised the fact that absentee Sinn Féin MPs have received £10 million in various allowances over the last 10 years alone. The Minister of State, Northern Ireland Office, the hon. Member for Wycombe (Mr Baker) said that he did not recognise the figure, so I asked the House of Commons Library to research it and it confirmed that it is correct. I then furnished the Minister and the Leader of the House with that. The Leader of the House is responsible for bringing a resolution that ends the scandalous anomaly where MPs whose leader has said that they have “no business in Westminster” continue to receive millions of pounds to do no business in Westminster. Has the Leader of the House indicated to you, Mr Speaker, that she plans to bring a resolution to end that scandalous anomaly?

Lindsay Hoyle: The quick answer is no, but I am grateful to the hon. Member for giving notice of his point of order. As he will know, I am not responsible for the accuracy of the contributions of Ministers or other hon. Members. If an error has been made, the record should be corrected. In any event, he has certainly put his points on the record.

Employment

Motion for leave to bring in a Bill (Standing Order No. 23)

Steven Bonnar: I beg to move,
That leave be given to bring in a Bill to make provision about employment rights, including the right to request more predictable terms and conditions of work; to amend the definition of worker; and for connected purposes.
Fairness, compassion and equality are not only the basics that should be afforded to each and every working person across these islands, but how we can measure the effectiveness of Governments for those they serve. The covid-19 pandemic has highlighted the many failings in legislative rulings on the workplace in this disunited kingdom. Working people have found that their workplace rights have not secured their jobs and incomes, their livelihoods or their health. Hundreds of thousands of people actually have few of the rights that Parliament has legislated an employee should have, such as the right to a minimum wage and protection against unfair dismissal. For far too many, persistent, undignified and unfair working practices remain their reality.
Workers’ rights are not a priority for this, or indeed any, Westminster Government. Despite committing to an employment Bill on at least 20 occasions so far, Ministers have shelved the legislation at each and every turn. Five years on from the Taylor review, we are yet to see action from the UK Government on improving workers’ rights. The omission of the long-anticipated employment Bill from the Queen’s Speech was yet another missed opportunity.
Last week, during Prime Minister’s questions, in relation to the Retained EU Law (Revocation and Reform) Bill, my right hon. Friend the Member for Ross, Skye and Lochaber (Ian Blackford) said that
“it is such a sad sight to watch this Prime Minister ram through a Bill that would rip up 4,000 pieces of European law—laws that protect workers’ rights, food standards and environmental protections.”—[Official Report, 30 November 2022; Vol. 723, c. 895.]
He was right. If the Tories were intent on protecting workers’ rights, they would simply retain and maintain those that were already enshrined in EU law. Of course, we know that they are either too proud or too pig-headed to admit that some EU law was good law and effective law, and that it protected our workforce. Instead, the Tories power it through, ignoring the fact that Brexit is the greatest political act of self-sabotage in the history of this state, and they further allow workers’ rights to degrade and for hard-working individuals to see their personal circumstances diminish.
If working people are to have a meaningful voice in setting the terms and conditions of their employment, and if callous unilateral decision making is to be stopped, questionable employers must be held to account. Remarkably, we find ourselves in the 21st century fighting 19th-century battles, despite the obscene wealth, progress and sophistication enjoyed by the few at the expense of so many. Under the Tories, the UK already has the highest levels of in-work poverty this century—poverty that disproportionately impacts on people facing high living costs, such as single parents, disabled people and people with caring responsibilities.
The Tory-made cost of living crisis is only further exacerbating matters. The Fawcett Society has said that women face “double trouble” because of the combined impact of the cost of living crisis and the difference in their pay compared with that of men. Research shows that in 2022 women will take home, on average, £564 less than men each and every month, and they are far more likely to be in low-paid employment. The Resolution Foundation has also found that low-paid work is often of poor quality, stressful and unfulfilling, and job satisfaction among the lowest earners fell from over 70% in the early 1990s to 56% as early as 2019. These are damning statistics.
Employers often try to persuade workers of the benefits of a lesser contractual status on the basis that it provides flexibility for the worker, but this is a false argument, since legal status has nothing whatsoever to do with whatever flexibility options employers confer on their workers. Flexibility can just as easily be enjoyed by employees if the employer is prepared to concede it.
This all points to a complete lack of consideration for employee lifestyle within the recommended practices placed on workplaces by this UK Government. Workplaces across the United Kingdom have been systematically plagued for years now by zero-hours contacts or work on demand-only requirements, while flexible contractual terms give wide-ranging powers to companies to dictate when, where and how work is to be done.
The emergence of fire and rehire as a corporate tactic is particularly galling to any of us from a true working-class tradition on the SNP Benches. My hon. Friend the Member for Paisley and Renfrewshire North (Gavin Newlands) has submitted two Bills to this Parliament seeking to outlaw fire and rehire practices, with the support of over 100 MPs and the backing of all major trade unions. This UK Government sit idle. In the meantime, collective bargaining coverage has plummeted, collective agreements now reach fewer than one in four workers, which is lower than at any time in the last 100 years. Those are damning statistics. This Bill seeks to ban the callous and sinister practice of fire and rehire once and for all.
The right to strike is constrained by unparalleled restrictions, although workers are now heroically voting in their millions to overcome them. It is no surprise that those working people’s share of the nation’s wealth continues to decline as poverty and inequality continue to increase, threatening the very basis of our threadbare democratic institutions. The differing rates of pay for young people are wholly unjust and discriminatory, and do not take account of people’s personal needs, responsibilities and living circumstances. A day’s work is a day’s work. The age of the person delivering that work should be of no relevance; only the quality of the work itself.
While the setting of the minimum wage is reserved to this place, the Scottish Government continue to encourage businesses in Scotland to pay the real living wage through  their Fair Work principles. The SNP also continues to oppose current rules on statutory sick pay, which fall far short of meeting a dignified standard of living and are not flexible enough to meet the real-life needs of real people. We have repeatedly called on the UK Government to increase SSP in line with a real living wage, and make it available to everyone by removing the requirement to be a qualified worker, removing the earnings requirement, and extending it to 52 weeks. Scotland’s ability to tackle unfair working practices and fully protect workers’ rights remains limited while employment law is reserved to this place.
Unaccountable power is unacceptable when exercised by the state, and it is no more acceptable when exercised by rogue employers. The measures proposed in a private Member’s Bill that was laid before the House by my hon. Friend the Member for Glasgow South West (Chris Stephens) aim to strengthen protections for workers with unfair contracts, including those with bogus self-employment and zero-hours contracts. I call on the UK Government either to get behind my hon. Friend’s Bill or to bring forward their own legislation to give millions of workers the same protections that are enjoyed by our friends and counterparts across Europe.
Scotland has everything it takes to be a hugely successful, self-governing, self- sustaining nation, and then we have so much more on top of that—only the staunchest Unionist would disagree. Yet Westminster control has held us back while comparable countries of a similar size go on to prosper. Relative to the UK, comparator nations have fewer people in gainful employment who are at risk of poverty. In the UK, 10.4% of those in work are at risk of facing poverty. In Belgium, Iceland and Finland, the figures sit below 5%. Furthermore, fewer employees are working long hours, with only 0.3% of workers in the Netherlands working more than 50 hours a week, compared with 10.8% of the UK’s population—those are damning statistics. Having the highest percentage of those employed experiencing in-work poverty should prompt this Government to act.
The UK under Conservative rule has experienced the largest wave of workers’ strikes in decades, and we now know that more is planned well into the new year. Protecting workers’ rights has never been, and will never be, a priority for this UK Government, who attempt to water down workers’ rights and take away any remaining dignity at every opportunity. Those practices, and this callous and uncompassionate culture, must end now. I urge the House to support a new dawn for workers everywhere—one that respects them, and holds their rights to the very highest standard.
Question put and agreed to.
Ordered,
That Steven Bonnar, Stephen Flynn, Mhairi Black, Colum Eastwood, Amy Callaghan, Jim Shannon, Patricia Gibson, Dave Doogan, Pete Wishart, Owen Thompson and Chris Stephens present the Bill.
Steven Bonnar accordingly presented the Bill.
Bill read the First time; to be read a Second time on Friday 3 February 2023, and to be printed (Bill 211).

Opposition Day - [9th Allotted Day]Opposition Day

NHS Workforce

Lindsay Hoyle: I inform the House that I have not selected the amendment. I call the shadow Secretary of State for Health and Social Care.

Wes Streeting: I beg to move,
That this House recognises that the National Health Service is facing the worst workforce crisis in its history with a shortage of 9,000 hospital doctors and 50,000 nurses; condemns the Government’s failure to train enough NHS staff to tackle this crisis; regrets that, as a result, patients are finding it impossible to get a GP appointment, ambulance or operation when they need one; calls on the Government to end the 200-year-old non-domiciled tax status regime which currently costs taxpayers £3.2 billion a year; and further calls on the Government to use part of the funds raised to invest in the NHS workforce by doubling the number of medical training places, delivering 10,000 more nursing and midwifery clinical placements, training twice the number of district nurses per year and delivering 5,000 more health visitors to guarantee that the NHS has the staff to ensure every patient can access the care they need.
The NHS is facing the worst crisis in its history. Seven million people are waiting for NHS treatment, and they are waiting longer than ever before; 400,000 patients have been waiting for more than a year. Heart attack and stroke patients are waiting an hour for an ambulance, on average, when every minute matters. “24 Hours in A&E” is not just a TV programme; it is the grim reality facing patients in an emergency. Behind those statistics are people being held back from living their lives: people forced to give up work because they cannot stand the pain; young people, still bearing the scars of lockdown, unable to get the mental health support they need to step into adulthood; families losing loved ones for no other reason than that the NHS was unable to treat them in time.
My friend and colleague the shadow Leader of the House shared with me an email from one of her constituents. A patient with suspected cancer was urgently referred by his GP, which ought to mean being seen by a specialist within a fortnight. Four weeks later he had heard nothing. He phoned the hospital and was told, “two weeks currently means six weeks” and that he would be contacted, not seen, within the next two weeks. He has now had his appointment, during which the doctor identified cancerous cells. He has been told that he will wait up to eight months to have that cancer removed. He said that until waiting lists are down,
“more people will die unnecessarily from cancer. I hope not to be one of them.”
That is not uncommon. That is where we are. That is why Labour is today putting forward our plan to solve this crisis, make the NHS fit for the future, and get patients treated on time again.

Alex Sobel: Yesterday I spoke to a paramedic who had been with a patient with sepsis, waiting for two and a half hours to be taken in. There were 98 calls at that same Yorkshire hospital  waiting to go in. Are we now post-crisis and in complete breakdown, and do we need Labour’s plans to come in now, and not have to wait?

Wes Streeting: I strongly agree with my hon. Friend. As the Leader of the Opposition has said, the NHS is not on its knees; it is on the floor. How many times were we told during the pandemic that restrictions were needed to stop the NHS falling over? It has now fallen over, and for the first time in its history people no longer feel certain that, when they phone 999 or arrive at A&E, they will be seen in time. It is the first time in our country’s history that people have not felt confident that emergency medicine will be there for them when they need it.
The Conservatives blame the crisis in the NHS on everything from the weather to the pandemic, and even NHS staff. Of course there is no doubt that the pandemic has made things worse, but the Government—the Conservative party—sent the NHS into the pandemic with 100,000 staff shortages. They spent a decade disarming the NHS, before sending it into the biggest fight it has ever faced. They cannot pretend that the NHS was well prepared. The problem for the Conservative party is that people are not stupid. Their memories are not that short. They know that the NHS was struggling to treat them on time before the pandemic, and they know who is to blame.

Luke Evans: Is not the point that health is devolved across four different nations, which are each led by a different party? Does this mean that the pandemic has hit all health services, including across the western world? This is a rising tide of the problem of the pandemic and dealing with an ageing population. This is not party political at all, and it is remiss of the hon. Gentleman to try to make it that. What does he say to that?

Wes Streeting: I would say two things. As I have already said, I accept that the pandemic made the challenge right across the United Kingdom worse. I also accept that, in every part of the United Kingdom, the NHS is under severe pressure. I would say two things in response. First, even if some of our friends on the SNP Benches do not want to acknowledge it, there is no doubt that every part of the United Kingdom would be better off with a Labour Government and every part of the NHS in every part of the United Kingdom would be better off if there were a Labour Government, because the investment that we are proposing in NHS staff today would benefit countries right across the United Kingdom. [Interruption.] In response to the outgoing hon. Member for Peterborough (Paul Bristow), do not say that politics does not make a difference. Do not expect the people to believe that somehow there was an inevitable sense of decline in the NHS. I am sure people remember that, when Labour was last in government, we delivered the shortest waiting times and the highest patient satisfaction in history.

Paul Bristow: rose—

Wes Streeting: Is the hon. Member planning to cross the Floor? I look forward to hearing from him.

Paul Bristow: Certainly not. The hon. Member’s plan seems to be simply vote Labour—there is no detail to it and nothing else to it. I suggest that he looks at the good people of Wales, who suffer under a socialist healthcare system. They are certainly not very happy, are they?

Wes Streeting: I do not pretend that our plan is not vote Labour, but of course those are the means by which we get to better ends. What we propose today is the biggest expansion of the NHS workforce in history. I will explain how that will benefit patients across the country and how we will pay for it. I think that people in Peterborough, 2,788 of whom are waiting more than a month to see a GP, will welcome Labour’s plan for investment. That is why, after the next general election, Peterborough will have a Labour MP.

Emma Hardy: I want to raise the case of my constituent, Mr Simpson, whose wife died last Tuesday after waiting 16 hours for an ambulance. On 29 November, his wife was confused. At 3 pm, he first called for an ambulance and was told that one might be sent and that he might hear from the service. At 6 pm, he rang the ambulance again. The person wanted to speak to his wife, but she was very confused and unable. He tried to give her a drink at 2.30 am; there was still no ambulance. His wife went to sleep, but she was still moving a bit. He fell asleep. He woke at 7.30 am and found that his wife was not moving; she had passed away. All the while they were still waiting for the ambulance to arrive. I do not believe for one moment that that happened because the ambulance service does not care. Does my hon. Friend agree that the service is desperately understaffed, desperately short of resources and in desperate need of adequate funding?

Wes Streeting: I thank my hon. Friend for raising that heartbreaking case. It is every family’s worst nightmare. All of us now know someone who is waiting for treatment. Many of us know someone who has called for an ambulance and waited for hours and hours—and, in some cases, given up on it and gone to hospital. I have spoken to ambulance service staff who, like many other staff across the NHS, feel a real sense of deep personal moral injury because they know that, despite their best efforts and busting a gut at work every single day, their best simply is not good enough because the system has collapsed. Ambulance turnaround times are not fast enough because A&E waiting times are too high. That is because people cannot see a doctor and the social care is not available, so the beds are full of people who are well enough to go home and would be better off at home. This is the problem in the NHS: the whole system is broken. I am afraid to say that political decisions made in this place by the Conservative party have led us to this tragic situation.

Andy McDonald: My hon. Friend is making an excellent case. At the James Cook University Hospital in Middlesbrough, the number of people still in hospital who could be discharged into social care amounts to three full wards. That is the situation that we have got to. It is a perfect storm, with ambulances queueing outside and people turning up at A&E because they cannot get to a GP. That will only  ever be addressed if we also address staffing in our GP services to ensure that they can attract people who are offered Agenda for Change terms and conditions to alleviate the backlog. Does he agree that we need to invest in all the elements along that supply chain?

Wes Streeting: My hon. Friend is absolutely right. This is the tragedy of where we have got to on social care in particular. The Government have allocated half a billion pounds to alleviate pressure this winter, but not a penny of it has reached social care providers. Not a penny of it is currently being worked in action to try to deal with delayed discharges. I have no doubt whatsoever that one reason why it has taken so long from that commitment to getting money to the frontline is the constant churn of Ministers that we saw over the summer. The absolute circus that we saw in the Conservative party has had a direct impact on the competence of effective Government in this country. We now have ineffective Government, so even when the Government seek to do the right thing and allocate the resources, they cannot get the money out the door far enough because Ministers seem to change week in and week out.

Jim Shannon: I commend the shadow Secretary of State for what he is saying. When it comes to staffing issues, one thing should clearly be done. Does he agree that part of the reason why we rely so heavily on agency staff is because our NHS staff have migrated to agency working, where there is less pressure, so the Government should spend less money on agency workers and give our NHS staff greater support and appropriate pay so that they can stay in the NHS?

Wes Streeting: I strongly agree with the hon. Gentleman. I will come shortly to talk about industrial action, but this should be at the heart of the Secretary of State’s thinking. The demands from staff trade unions, whether on pay, terms and conditions or the wider pay machinery, should be seen not just as a negotiation with staff unions but as a retention issue. We are losing staff faster than we can recruit them in some places—especially in areas such as midwifery—and if we lose the staff that we have, even Labour’s plans to undertake the biggest recruitment in the NHS’s history would not be as effective as they would be if we kept staff in the service today. That is why I urge the Secretary of State to treat those NHS staff with respect, get their representatives around the table, and negotiate a solution.
I am aware that the situation in the NHS in Northern Ireland is the worst that we see throughout the United Kingdom. The shadow Secretary of State for Northern Ireland, my hon. Friend the Member for Hove (Peter Kyle), visited NHS services in Northern Ireland only recently. I have no doubt that we need to get effective governance back up and running again in Northern Ireland as well. I urge the Government to discharge their responsibilities in that area, too. Certainly, when Labour was last in government, I do not remember Labour Prime Ministers taking such a complacent, lackadaisical or indeed absent approach to the governance of Northern Ireland. I hope that we can see a breakthrough of the deadlock so that the people of Northern Ireland get the Government they deserve in Stormont, as well as the United Kingdom getting the Government it deserves here in Westminster.
Waiting lists were already at a record 4.5 million before the pandemic. Ambulances were taking longer than is safe to reach patients in an emergency before the pandemic. Patients were waiting longer than four hours in A&E before the pandemic. The 18-week guarantee for elective treatment had not been met for four years before the pandemic, and more patients have waited longer than two months to start their cancer treatment every year since 2010. From the moment the Conservatives entered power, things began to deteriorate. It is not just that the Conservatives did not fix the roof while the sun was shining; they blew off the roof and ripped up the floorboards, and then they wonder why the storm did so much damage.

Charlotte Nichols: My hon. Friend mentioned cancer diagnosis rates. I believe he will be aware that one in four people diagnosed with pancreatic cancer dies within a month of their diagnosis, with 70% receiving no treatment at all because they die before they could be treated. Does he agree that cancer diagnosis rates are a disgrace and that early intervention, early diagnosis and early treatment are vital for people with all forms of cancer, particularly the most aggressive types such as pancreatic cancer, to have any chance of survival?

Wes Streeting: My hon. Friend is absolutely right. One reason why this country has much poorer cancer outcomes than many comparable economies is precisely because of late diagnosis. I know from my own experience how vital early diagnosis can be for good cancer outcomes. I am terrified by the fact that, within those 7 million patients waiting in the elective backlog, there will undoubtedly be cases of undiagnosed cancer and other conditions. If the NHS had eyes on the patients, they would be detected faster, patients would receive treatment much more quickly and the outcomes would be better. One of the tragedies for the NHS is that, because we do late diagnosis, we get more expensive and less effective treatment. If we could diagnose faster, patients would get better outcomes and taxpayers better value for money. That is the kind of reform to the model of care that Labour would like to see.

Wera Hobhouse: On diagnosis, access to GPs is also a vital part of the puzzle. Is it not terrible that the Government are not listening to GPs, who say they need a different visa system? They cannot recruit enough GPs into the system because the Government are so stuck with these immigration rules, and the Home Office does not want to change certain parts of the visa system?

Wes Streeting: I am grateful for that intervention. We are in the worst of all worlds on immigration and the NHS. The Government try to have it both ways. They talk tough on rhetoric, so we end up with a very bureaucratic, ineffective and costly system, but because they fail to invest in our own homegrown talent, they are over-reliant on immigration from other countries, including those who desperately need their own doctors and nurses. I do not think it is good enough, after 12 years of Conservative Government, that we are turning away bright potential doctors, nurses and allied health professionals because the Government cannot be bothered to pull their finger out and train our own homegrown talent. We need to see improvement, so we  that can draw the best international talent and make the system smooth, efficient and effective, but it is also crucial that we train our own homegrown talent.
Turning to more of the Conservatives’ excuses—we have heard the excuses of the pandemic—let us now look at the excuse they are planning to deploy this winter. There is no denying that this winter could be the most challenging the NHS has ever faced. The Royal College of Nursing, for the first time in its more than 100-year history, is planning to undertake strike action. Just this lunchtime we got strike dates from Unison, the GMB union and Unite the Union. That raises the question: why are the Government not even trying to stop the strikes in the NHS from going ahead? Surely, when the NHS already lacks the staff it needs to treat patients on time, the Government ought to be pulling out all the stops, getting around the table and negotiating to stop industrial action? So why aren’t they?
The Secretary of State said in Health questions earlier that his door is open—as if we can just sort of wander in off the street into the Department of Health and Social Care, where there will be a cup of tea and a biscuit waiting, and he will be just waiting for the negotiations. That is not how this works. Everyone knows that is not how it works. He had a nice little meeting with unions after the summer, after Labour complained that we had not seen a meeting between a Secretary of State and the unions since the right hon. Member for Bromsgrove (Sajid Javid). Goodness me, we have had three Secretaries of State since then—and two of them are the Secretary of State on the Front Bench today. Why on earth are they not sitting around the table and conducting serious negotiations? I will tell you why, Mr Deputy Speaker: they know that patients are going to suffer this winter and they do not have a plan to fix it, so instead of acting to improve care for patients and accept responsibility, they want to use nurses as a scapegoat in the hope that they avoid the blame. We can see it coming a mile off. It is a disgusting plan, it is dangerous and it will not work.
If I am wrong, perhaps Conservative Members could explain why the Government are not trying to prevent the strikes from going ahead. Perhaps they could explain why the Secretary of State ignored all requests from the health unions for meetings and conversations this summer while the ballot was under way. Perhaps they could explain what the Government’s plan for the NHS is this winter. Perhaps they could explain why a Government source told The Times newspaper that
“Ministers plan to wait for public sentiment to turn against striking nurses as the toll of disruption mounts”.
They said the quiet bit out loud and they gave the game away.
What else would explain the unedifying and embarrassing spectacle of the chair of the Conservative party going on national television to accuse nurses of doing the bidding of Vladimir Putin? I should not have to make this point, but nurses are not traitors to this country. They bust a gut day in, day out to look after all of us. We clapped them during the pandemic and now the nurses are clapped out. They are overworked, overstretched and undervalued by this Government. Let me say to the chairman of the Conservative party that he would speak with greater authority on what is in Britain’s national interests if he did his patriotic duty in his own tax affairs.
When it comes to sending a message to Vladimir Putin, why does the burden consistently fall on the working people in Britain? Why is it that NHS staff must make huge sacrifices because of the invasion of Ukraine, yet people who live in Britain but do not pay their fair share of taxes here do not have to lift a finger? When it comes to paying the bills, the first and last resort of this Conservative Government is always to pick the pockets of working people, yet the enormous wealth of tens of thousands of non-doms is left untouched. They may blame covid, they may blame health professionals, they may even blame the weather, but it is 12 years of Conservative mismanagement and under-investment that has left the NHS without the doctors, nurses and staff it needs, and patients are paying the price.
I am sure every Member of this House, indeed everyone in the country, knows someone who has been let down when they needed healthcare in recent months. They all say the same thing: the NHS staff were brilliant, but there simply are not enough of them. There is no NHS without the people to run it, yet today there are more vacancies in the NHS than ever before: 9,000 empty doctor posts, 47,000 empty nursing posts, and midwives leaving faster than they can be recruited. There are 4,600 fewer GPs than there were a decade ago, and the right hon. Member for Bromsgrove admitted last year that the Government are set to break their manifesto promise to recruit them back.

Helen Hayes: I was looking at a message from a constituent this morning who told that he went to A&E having waited four weeks for a GP appointment. Does that not speak to a lack of investment in the NHS workforce over 12 years and a lack of adequate planning? I know how hard GPs work in my constituency, but the lack of GP availability to staff surgeries and provide those appointments is placing unneeded pressure on A&E. That is on this Government’s watch.

Wes Streeting: I wholeheartedly agree with my hon. Friend. As we see so often with this Government, they make promises but break them. They try to fool the public into thinking they are delivering more GPs—or indeed more police officers—when it was the Conservative party that cut them. They try to give with one hand, but they take with the other, and after 12 years people have had enough.
Of course, it is not only the promise to recruit more GPs that the Conservatives are breaking. We had the promise of 40 new hospitals, which the Secretary of State repeated today, yet in response to the question posed by the right hon. Member for Uxbridge and South Ruislip (Boris Johnson), the Secretary of State said that of those 40 new hospital schemes
“five hospital schemes are in construction, two are now completed and we aim to announce the next eight by the end of this year.”
So, where are the other 25? Where are these 40 new hospitals? As far as I can tell, they exist only in the imagination of the former Prime Minister. Yet the script has not changed—Ministers are still here claiming 40 new hospitals.
When I visited Leeds with the shadow Chancellor, my right hon. Friend the Member for Leeds West (Rachel Reeves), I saw a vast pile of dirt where a new building  was due to go up. We heard today that the Government cannot even negotiate an agreement with the hospital to get the site working and get the new facilities built. With every minute, every month and every year of delay construction costs are going up, so taxpayers are left in the worst of all worlds: broken promises, no 40 new hospitals, and paying through the nose for the ones that are being built because of Government incompetence.
We see the tragic consequences of the shortages and broken promises in the NHS. My hon. Friend the Member for Rotherham (Sarah Champion) raised the tragic case today at Health questions of a five-year-old boy who had what his doctor described as the worst case of tonsilitis he had ever seen. He was turned away from hospital, with his parents told there were no beds and not enough doctors. His infection worsened and five-year-old Yusuf later passed away. His death certificate recorded the primary cause of his death as pneumonia and the secondary cause as tonsilitis. What kind of country are we living in when a five-year-old boy can die of tonsilitis? This is criminal.
I met Yusuf’s uncle, Zaheer Ahmed, last week, and I did not know what to say to that poor man and his grieving family, who lost that little boy in the most unimaginable circumstances. I invite the Secretary of State to meet Yusuf’s family to hear how that little boy was failed and to hear at first hand about some of their interactions with the NHS, which I thought were completely unacceptable and intolerable. On that note, I welcome the independent inquiry that has been committed to. That is really important for the family who have been failed in this heartbreaking case. We do not want to see more cases like that.
At the heart of the crisis in the NHS—as with so many of the problems facing our country—is a failure to plan. The NHS has not had a workforce plan since 2003. That would be unacceptable in a multinational company one one-hundredth the size of the NHS. The failure to plan means that short-term fixes are always favoured over what is in patients’ long-term interests. That is why the Government cut the nursing bursary and why, this summer, in the middle of the biggest crisis in the history of the NHS, they took the infuriating decision to cut a third of medical school places.

Luke Evans: Will the hon. Gentleman give way?

Wes Streeting: The hon. Gentleman has been to medical school; does he think that it was a good idea to cut the number of places this summer?

Luke Evans: When we talk about Labour’s record on training, the hon. Gentleman may forget that, in 2007, the medical training application service ended up in judicial review. Many of my colleagues moved out of disciplines that they loved dearly because of Labour’s mess in making those plans. He has been speaking for almost half an hour, setting out his exposé of what is going on in the health service, but I am yet to hear a plan. I hope that he will spend the next half an hour telling us about the detailed plan of how we get to 10,000 new medical places, because when it comes to firms in hospitals, there is not enough space for medical students to get that experience, so I am looking for him to solve that problem.

Wes Streeting: The hon. Gentleman is not looking forward to me solving the problem half as much as I am looking forward to solving the problem. As far as I am concerned, the general election cannot come soon enough. I say to Government Members, “Be careful what you wish for”, because I intend, indeed, to set out Labour’s plans in detail. I am happy to stretch that to half an hour if that is where the demand takes us.

Daisy Cooper: rose—

Wes Streeting: I give way to my Liberal Democrat friend.

Daisy Cooper: I am grateful for a number of the interventions, not least the most recent one. Is it not true that, as hospital trusts meet with regard to the new hospital programme today, they will discuss how big the new hospitals should be? Given that we need more space to train the doctors and nurses of the future, does the hon. Member agree that it would be criminal if they tried to cut corners by planning hospitals that are smaller than they need to be?

Wes Streeting: I wholeheartedly agree. I seemed to hear from the Health Secretary this afternoon a one-size-fits-all approach from the Government, as though every hospital’s needs will be the same and we can import a standardised model for every hospital site. I would be happy to be proven wrong, and I would be even happier if the Secretary of State got the ball rolling on some plans that are already agreed, and on which trusts have spent a significant amount of time and taxpayers’ money. I would be even more delighted if we got some of those hospitals open, but I would wager that when we get to the end of the Government’s life, we will not have seen anything like 40 new hospitals delivered or even in the pipeline.

Peter Dowd: My hon. Friend is making a compelling case. I think I know where we could get some of the money from for training places, and perhaps he will agree. We forgo about £3.2 billion in revenue from non-doms every year. There are 68,000 non-doms, there or thereabouts, which works out at about £44,000 a non-dom. Does he think that he could do much with that?

Wes Streeting: My hon. Friend has led me neatly towards setting out Labour’s plans, which rely on people who come to this country and make Britain their home actually paying their taxes here. That is the right and fair thing to do, and I think people across the country would agree that we need nurses more than we need non-doms.

Charlotte Nichols: I have listened with interest to what has been said about the new hospital building programme, not least because we have been waiting for a new hospital in Warrington for a very long time. We recently opened the new Health and Social Care Academy at Warrington & Vale Royal College with some of our town deal fund money, but surely people need excellent, cutting-edge training facilities to go into in a hospital once they leave the college. The Government’s lack of progress on building us a new hospital in Warrington undermines some of the other excellent work that we are doing locally to try to train up the people we need to fill those workforce shortages.

Wes Streeting: I totally agree, and I heard of a really awful case in Warrington the other day. A Warrington resident who contacted me said that they waited 12 hours in agonising pain in accident and emergency before giving up and going home after midnight because she simply could not take it any more. The A&E department was so packed that she could overhear other patients’ conversations with clinicians, including sensitive medical information. Those are the kinds of conditions that patients are experiencing and in which the poor NHS staff have to work. It is simply unacceptable.

Claire Hanna: I thank the hon. Gentleman for being so generous in giving way. Does he agree that keeping the working environment safe is core to workforce planning, retaining the people who are trained and stopping spending eye-watering sums on agency nurses? He outlined many scenarios in which staff are forced to work in unsafe conditions. Does he agree that the core message coming from health unions is their desire to have appropriate staffing levels to provide the service on which all our constituents rely?

Wes Streeting: I strongly agree. In fact, I spoke to the general secretary of Unison last week. She said that as the unions look at safe staffing levels in critical services, in their determination to maintain patient safety in the event that industrial action goes ahead, they have found that on non-strike days, the NHS already operates at staffing levels below what the union would intend to operate on a strike day. That is an unbelievable state of affairs.
I am really worried about industrial action. Like patients across the country, I do not want industrial action to go ahead—it will mean ambulance delays, cancelled operations and even greater pressures on the NHS—but the tragedy is that we see the conditions that I just described every single day in the NHS. Pat Cullen from the Royal College of Nursing said, “We are striking for patients”. I have heard that line time and again from RCN members. It is partly about NHS staff’s pay and the conditions in which they work, but more than anything else, they are telling me that they voted for industrial action—some for the first time in their entire careers—because they have had enough and can no longer suffer the moral injury of going to work, slogging their guts out and going home petrified that, despite their best efforts, they still did not deliver the care that patients deserved. What an intolerable situation they find themselves in. Their backs are against the wall, and that is why the Government should negotiate.

Yasmin Qureshi: My hon. Friend is making an excellent speech. Does he agree that it is completely reprehensible for Government Ministers, when talking about potential pay strikes by nurses, to say that by going on strike, they are somehow enabling Putin’s regime?

Wes Streeting: That was a reprehensible thing to say and it shows how desperately the Government are scraping the barrel to make excuses for their negligence and mismanagement of the NHS.
As I said, I found it astonishing that this summer, in the middle of the biggest crisis in the history of the NHS, the Government took the infuriating decision to   cut a third of medical school places. Thousands more straight-A students in Britain who want to help have been turned away from training to become doctors. It is like the clip of the former Deputy Prime Minister Nick Clegg saying in 2010 that there was no point in building new nuclear power stations because they would not come online until 2022. This country needs Governments who think beyond short-term electoral cycles and put the long-term interests of the country first. That is the approach that Labour would take, but it has been sadly missing for the past 12 years.
Just as the Government failed to build our energy security, leaving us exposed to Putin’s war in Ukraine, they failed to train the staff the NHS need, leaving us exposed as the pandemic struck. Their failure to prepare has left us in the ludicrous situation in which UK universities are now offering medical degrees only to overseas students. That’s right: the Government are refusing to allow bright British students to achieve their dreams of becoming doctors, so Brunel University is forced to take exclusively students from overseas. The Chair of the Select Committee on Education, the hon. Member for Worcester (Mr Walker), has warned that there is a real risk that medical schools will
“only train overseas students who go off and get jobs elsewhere”.
What a criminal mismanagement of our higher education system. What a failure to plan to meet our staffing needs with our own home-grown talent.

Taiwo Owatemi: My hon. Friend is making an excellent point. Given that there were nearly 30,000 medical school applications last year from British students who really want to study medicine, does he agree that it is absolutely disgraceful that the Government have a cap of 7,500? That shows that we are not investing in our workforce or in home-grown British doctors. It is appalling that the Government cannot see the importance of that.

Wes Streeting: I wholeheartedly agree. To deal with that problem—and, indeed, to satisfy the demands of the Conservative party, which looks to Labour for answers—we are putting forward a plan today to solve the crisis, to bring down waiting times, to get patients the treatment they need and to build a healthy society.
Where the Conservatives are holding the best and brightest students back from playing their part in the health of our nation, Labour will unleash their talent in the NHS: we will double medical school places, training 15,000 doctors a year so that patients can see a doctor when they need to. Where the Conservatives have left nurses working unsafe hours, unable to spend the time they need with patients to provide good care—where the Conservatives have left the NHS so short of midwives that expectant mothers are turned away from maternity units that do not have the capacity to deliver their child—Labour will act: we will train 10,000 more nurses and midwives every year.
We will go further. The way we deliver healthcare has to change. For many patients, a hospital is not the best place to be, yet in the past 12 years all the other parts of our health and care service have been eroded by underinvestment. When our society is ageing and people increasingly want to be cared for in the comfort of their  own home, surrounded by their loved ones, why have four in 10 district nursing posts been cut? Labour is proud to have district nursing at the heart of our plans to modernise the NHS, and we will double the number of district nurses qualifying every year.
Many colleagues across the House have campaigned for years on the importance of the early years of a child’s development. All the evidence says that the first 1,000 days of a child’s life are vital to their development and life chances, yet the number of health visitors has been cut in half since 2015. Labour will ensure that every child has a healthy start to life, training 5,000 more health visitors. That is what our motion would deliver.

Munira Wilson: The hon. Member raises children and early intervention, but one area he has not touched on is the tidal wave of cases relating to children and young people’s mental health. As we all see in our casework every week, children and young people who have not been treated early get worse and worse and therefore get referred to acute services. In the past year, referrals to child and adolescent mental health services have gone up almost 25% and consultant psychiatrist numbers have come down. In terms of early intervention, we are not seeing enough mental health support in our schools. In Richmond, we cannot recruit clinical psychologists even though we have the money to do so. Does the hon. Member agree that we really need to focus on the future of this country—our children—by training more psychiatrists, counsellors and psychologists?

Wes Streeting: I totally agree. We have had lots of perfectly good speeches from Conservative Prime Ministers over the past 12 years, and we have had more than our fair share of unbelievably bad Conservative Prime Ministers over the same period. One thing that each of those speeches has had in common is warm rhetoric and no delivery. We are not prepared to make the same mistake, so although it is not on today’s Order Paper, I am pleased to confirm that my right hon. and learned Friend the Leader of the Opposition has announced a mental health pledge that will mean 8,500 more mental health professionals being recruited. It will enable us to provide mental health hubs in every community, dedicated mental health support in every school and the aim of guaranteeing treatment within a month.
Our pledge will be transformational to mental health support in this country. It will particularly benefit young people, whose mental health and wellbeing have borne the brunt of the pandemic. It will really help to free up capacity for GPs and accident and emergency departments, which are increasingly seeing mental ill health cases coming through their door because the specialist support that people need is unavailable. Our plan, like our motion on today’s Order Paper, is fully costed and fully funded and will make a real difference to patients. Just as the Conservative party is welcome to steal Labour’s NHS workforce pledge, it is very welcome to steal our mental health plan too.
As well as recruiting the doctors, nurses and allied health professionals we need, we also need to keep the staff we have.

Mike Amesbury: Why does my hon. Friend think Government Members are so keen on protecting non-dom status? What is the interest there?

Wes Streeting: That is an excellent question that the Secretary of State is really well placed to answer. It is not as if people in Downing Street do not know what non-dom status is or how it is currently accessed. I do not know whether the Chancellor’s reluctance to abolish non-dom status is because he does not want bad relations with his next-door neighbour. We have all been in that situation—everybody needs good neighbours—but I think a little neighbourly discomfort on Downing Street is a price worth paying to improve the healthcare available to people on streets up and down the rest of the country.
We need to keep the staff we already have. On a visit to a hospital recently, I spoke to a nurse about whether she was planning to vote for industrial action. She said yes: pay was an issue, but what really motivated her decision was the stress, the burnout and going home at the end of the day with the moral injury of worrying that she had not delivered the care patients deserve because she was too overstretched. I asked her what would make the most difference. She said, “I just want to know that the cavalry is coming—that it is worth staying in the job because things are going to get better.” She knows how long it takes to train nurses—she has been through it herself—and how long it takes to train doctors. She can accept that, but what she cannot accept is a future in which, because we did not act today or because the incoming Government did not act after the general election, she is still working understaffed shifts in overstretched hospitals a decade down the line.
Labour’s message to NHS staff is that the cavalry is coming with Labour. We will train a new generation of doctors, nurses and midwives so that staff are not driven out of the service and patients are treated on time. Of course more can be done to keep staff from leaving. We have been calling on the Government for months to fix the perverse incentives in doctors’ pensions that are forcing them into early retirement. The Government have just launched a consultation that might lead to changes in spring 2023. What good is that when the NHS is on the cusp of the worst winter crisis in its history?
The Government announced in the autumn statement that, for the first time ever, they would count the number of staff the NHS need—a truly groundbreaking act! Counting the number of people we need is a good start, but Labour has committed to an independent workforce body that will look at retention and better professional development so that staff can build and progress their careers in the health service. With the number of care workers falling for the first time, where is the Government action to stop the exodus of care workers to places like Amazon? Providing fair pay and terms and conditions for care workers is not only the just thing to do, but one of the best things that the Government can do to ease pressure on the NHS.

Jonathan Edwards: Is there not a need for urgent thinking about the impact of inflationary pressures on all the UK’s health systems in the UK? According to a report published yesterday by the Wales Governance Centre at Cardiff University, inflation will eat into the Welsh budget to the tune of £800 million next year and £600 million in 2024-25. Health is at the heart of the Welsh budget, and this will inevitably have a huge impact on health delivery in Wales. I am not sure what the English figures are, but  the cash-terms increases in the autumn statement are highly unlikely to compensate for the inflationary pressures that will also affect the English health budget.

Wes Streeting: The hon. Gentleman is right: inflation is a big problem, and it is a problem made in Downing Street. We are all paying a very heavy price for more than a decade of Conservative mismanagement of the economy. Yes, we can all point to the spectacular success that was the mini-Budget, which crashed the economy and left everyone picking up the pieces, but even that does not explain more than a decade of low growth, low productivity and higher taxes. That is where the Conservative party has left us, and that is why it is not just a change of NHS policy we need, but a change of economic policy. Goodness me, the Conservatives have had enough goes at it. They have had enough Chancellors this year. Even The Spectator has lauded the shadow Chancellor as the Chancellor of the year, because she has the plan that the country needs. Business leaders know it, we know it, the country knows it, and I suspect that even Conservative Members know that it is true.
Let me now turn to our NHS workforce plan. When I say that it is a serious plan, the House should not just take my word for it. It has been endorsed by the Royal College of Physicians, the Royal College of Psychiatrists, and Universities UK. It has widespread and cross-party support. I was particularly pleased by the support expressed by one correspondent, who wrote in September:
“I very much hope the government adopts this on the basis that smart governments always nick the best ideas of their opponents. They also ditch the bad ones of their predecessors such as blocking an enlightened amendment to the Health Act that would have sorted out workforce planning”.
I should like to thank the Chancellor for his endorsement. I was with him in the Lobby to support that NHS workforce amendment when Conservative Members, no doubt including the Secretary of State, were voting the other way. May I invite the Secretary of State to use that quote in any future negotiations in which he engages at the Treasury? I am just trying to be helpful.
While the Secretary of State is there, perhaps he could suggest that the Treasury take a proper look at the non-dom tax status. The Chancellor admitted after the latest Budget that his team had not even calculated how much the tax status was costing the Treasury and how much scrapping it would raise, at the same time as expecting us to believe that it would not work and that the sums produced by independent academics would not add up, although he had not even bothered to commission Treasury sums of his own.
Politics is about choices. The Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, while millions of people cannot get a GP appointment or an operation when they need one. The Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, while millions of people are left waiting in agony on NHS waiting lists. And, of course, the Conservatives are choosing to protect non-dom tax status, benefiting a few wealthy individuals, when they know that it is not just the health of the nation that is being harmed by record NHS waiting lists, but the health of our economy. Patients need treatment more than the wealthiest need a tax break. Those who live in Britain should pay their taxes. The Labour party is clear about where we stand: we need nurses, not non-doms.
We have a plan. The Conservatives do not. We have a record of delivering in government. The Conservatives do not. It is not just the House that faces a choice today; at the next election, the country will face a choice between more of the same with the Conservatives and the fresh start that Britain needs with Labour.

Steve Barclay: The hon. Member for Ilford North (Wes Streeting) said that Labour has a plan. Let us look at that plan. More than a fifth of the entire population of Wales are waiting for planned care, and 60,000 people in Wales are waiting for more than two years. So we can see exactly what Labour’s plan in government delivers. He asked us to remember when Labour was last in power, and we still do. We remember the letter that said there was no money left. [Interruption.] He has just had plenty of time in which to discuss these matters. I did not feel the need to hector him, because I thought his points had so many flaws that it was important for the House to be able to hear them. He obviously feels that he did not make his case effectively, and would like to have another go. Does he want to have another go?

Wes Streeting: indicated dissent.

Steve Barclay: He does not want to intervene, so let me deal first with what he left out. His speech, like his motion, ignored a number of salient points. He did not mention, for example, the autumn statement, which one would have thought was fairly significant, providing an extra £6.6 billion for the NHS over the next two years. The NHS Confederation, no less, has described the day of that settlement as a “positive day for the NHS”, and the chief executive of NHS England has said that it should provide “sufficient” funding to fulfil the NHS’s key priorities.
The hon. Gentleman chose not to mention that significant funding. He also—much to the surprise of the House, perhaps—chose not to mention the uplift for social care that was announced in the autumn statement. Opposition Members often call for more funding, so I would have thought that they would be keen to hear about the extra £6.6 billion of additional funding for the NHS, about the biggest funding increase for social care provided by any Government in history, and about the £8 billion that we have committed to elective care. That, bizarrely, was also missing from his speech. He talked about the backlogs—those in England, that is; the backlogs in Wales are much greater—but he did not talk about that £8 billion for elective care, which will fund the building of diagnostic centres and surgical hubs in the constituencies of many Opposition Members.

Debbie Abrahams: rose—

Steve Barclay: I do not know whether there is a community diagnostic centre for a surgical hub in the hon. Lady’s constituency, but perhaps she will share with the House what extra investment is being made there.

Debbie Abrahams: As someone who worked in the NHS during the last period of Labour government, I was proud of being able to ensure that my constituents would have an appointment with a GP within 24 hours. I was proud of the fact that someone who needed elective care would receive it within 18 weeks. I was proud of the fact that the treatment of someone diagnosed with cancer would start within 60 days. That is not what is happening on the Secretary of State’s watch. Can he tell me why my constituency has fewer GPs than it had in 2015, along with an increase in demand? How is this delivering the quality care that I know we had on my watch and that of the last Labour Government?

Steve Barclay: We are investing in more doctors. We have 2,300 more doctors—a 3% increase. We also have 3% more nurses than we had last year. In fact, under the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May), there was the biggest  ever increase in medical undergraduate places—a 25% increase—along with the opening of five new medical schools. Of course, the training takes about seven years, so that is still in progress. As was pointed out during Health questions this morning, we are dealing with the consequences of the pandemic, which is why we are investing in more checks, scans and other procedures, and there will be an extra 9 million of those by March 2025.

Emma Hardy: The right hon. Gentleman might recall that, when he was previously Health Secretary before his short break, I raised concerns around the criteria to reside and the number of people remaining in Hull Royal Infirmary who were unable to move into adult social care. At the moment, we have 30% vacancies in adult social care. The problem is that, although the money is promised, it is not delivered. That is partly because of the chaos that we have seen in the Government. He must acknowledge that, although this money was promised, it was not delivered and that we have 30% vacancies in adult social care across Hull and East Riding. Those vacancies always increase before Christmas because retail makes an attractive offer to those same workers. The money has not been delivered in time, and those 30% vacancies are only going to increase. With the greatest respect to the Secretary of State, there is little point in making promises if they are not quickly delivered in time to make a difference.

Steve Barclay: The hon. Lady mentioned the summer, and I think she knows that I visited the Jean Bishop integrated care centre and looked at the great innovations and brilliant work that her constituents, among others, are doing there. I looked at how it is bringing social care and the NHS together through an integrated model and how there has been new investment, supported by the amazing fundraising within the local community and by NHS funding. It would be great to get a bit of balance about the amazing feedback I heard from both staff and patients at the Jean Bishop integrated care centre who are working innovatively. I hope the hon. Lady would agree that the innovation of a centre such as the Jean Bishop is what we need to see in more places across the NHS. To her wider point, there are challenges in social care; she raises a fair point. That is why, despite the many competing pressures that the Chancellor faces, he has allocated £500 million for this year. It is also why  he then committed the £2.8 billion for next year and the £4.7 billion for the year after—the biggest ever increase in that funding. But it is not simply about the funding increase; it is also about using new models such as that integrated care model to deliver far better care.

Luke Evans: Is that not precisely the point? The NHS will gobble up the money, so it is about how we use the system. The integrated care systems and integrated care boards—established through the White Paper that the NHS asked for—are doing exactly that. They are trying to join up primary care, secondary care, social care, preventive health, county councils and borough councils all in one place to make a better stand on how we can produce healthcare that is better for our constituents and better for the taxpayer. Will my right hon. Friend make sure that, when he goes to the integrated care board chairs, he gives them the chance to solve the problems and unleashes the power to do exactly that, because they know best?

Steve Barclay: My hon. Friend raises an extremely important point. It is not just about the significant funding increase that the Chancellor has allocated; it is also about how that funding is deployed, in particular through using population level data for the integrated care system to bring health and care together. One area that the hon. Member for Ilford North and I agree on is the impact of delayed discharges across health and our hospital trusts as a whole. We often see that manifested in ambulance handover times, which are so impacted by that.
On the investment that is going in, my hon. Friend the Member for Bosworth (Dr Evans) is right to say that it is also about how it is deployed. Again, missing from the Opposition motion was any reference to the commissioning of the former Labour Secretary of State, Patricia Hewitt, to look at how to take on board how that funding is spent in an integrated way. It would also be remiss of me not to draw the House’s attention to the £5.9 billion of capital funding that we are using to transform diagnostic services by making the most of new technologies and improving the equipment for our frontline staff, making it easier for them to deliver the patient outcomes that we need. That is investment, along with the investment in care, that this Government can be proud of.
In the motion, the shadow Secretary of State refers to a shortage of workforce, but he ignores the locum doctors and bank nurses that make up a significant proportion of the NHS workforce. He ignores the record numbers of doctors and nurses that we now have working in the NHS, with a 3% increase on last year in both doctors and nurses.
I am sure you will be surprised, Mr Deputy Speaker, given your background in Wales, to discover that we cannot see what the vacancy rate is in Wales because the Welsh Government stopped collecting workforce vacancy statistics in 2011. You would have thought that the motion would be an opportunity for the Opposition to encourage their Welsh colleagues, given the importance that they say applies to vacancy statistics. You would have thought they would be keen to see that information from across the Union of the United Kingdom. I thought that Labour was a party of the Union. Why would it not want to have that transparency across Wales on the  vacancy figures? But the motion was silent on that point. Perhaps in closing, the relevant shadow Minister will make a commitment to encourage the Welsh Government to have that same level of transparency.

Luke Evans: The Secretary of State hits the nail on the head when it comes to comparing the different countries across the Union, because different countries choose to use different statistics on waiting times to manage their staffing. Does this not confirm the argument we should have a unified way of using those statistics across the four nations?

Steve Barclay: I very much agree. In fact, in the spirit of co-operation, I would be happy to write to Sir Ian Diamond at the Office for National Statistics to encourage that, if the Welsh Government were willing to make that commitment. I do not know whether the Opposition would be willing to sign up to encouraging the Welsh Government to have that level of transparency. They seem reticent about having that transparency.

Karin Smyth: Going beyond the party knockabout, I think that the issue of statistics across the Union is a really important one, and I have raised it in the House many times. Can the Secretary of State tell us what the vacancy rate is in North East Cambridgeshire?

Steve Barclay: Well, it depends on what we are talking about. Are we talking about doctors or nurses? Are we talking about locums? Are we talking about the churn within care? There is a range of factors. The reality is that we do not have a major hospital in North East Cambridgeshire. We are served by four different hospitals, at King’s Lynn, Peterborough, Hinchingbrooke and Addenbrooke’s. Someone particularly interested in data would need to look across those ranges.

Karin Smyth: rose—

Steve Barclay: Let me make some progress.
There is a fair list of omissions in the motion. It did not talk about how the Government are on track to deliver their manifesto commitment of 50,000 nurses by 2024, with nursing numbers over 32,000 greater than they were in September 2019, and the fact that there are over 9,300 more nurses and almost 4,000 more doctors than there were a year ago. There has also been a 47% increase in the number of consultants since 2010.

Wera Hobhouse: The biggest problem for my constituents is access to GPs because there are not enough GPs in the system, so rather than talking about statistics, how can the Secretary of State make sure that my constituents can see a GP in time and not walk away in desperation because they cannot get an appointment?

Steve Barclay: I agree that it is not simply about statistics, but I think it is remiss not to point to the increase in doctor numbers, with 2,300 more in primary care—

Karin Smyth: Will the Secretary of State give way?

Steve Barclay: Can I just answer the hon. Member for Bath (Wera Hobhouse)? I have taken a number of interventions. The hon. Lady is intervening on an intervention.
We must look at the increase in doctors in primary care of over 2,300, and we currently have over 9,000 GP trainees, but the hon. Member for Bath’s wider point is correct. It is not simply about the number of GPs; it is about ensuring that the wider primary care force operate at the top of their licence. It is also about access for patients, and avoiding the 8 am Monday crunch when lots of people make calls at the same time. That is why we are looking at the better use of telephony in the cloud and the latest that technology offers. It is also why we have the opportunity, through Pharmacy First, to make better use of what the pharmacists throughout our pharmacy network can do. It is about increasing the number of GPs, yes, but it is about the wider workforce, the use of technology and the use of different patient pathways, too.
Another omission from the motion is that there are around 90,000 more GP appointments every working day, excluding covid vaccinations, than there were last year. When I hear people say that they cannot see their GP, it is worth putting it in context—[Interruption.] The shadow Secretary of State is chuntering again. Does he want to have another go?

Wes Streeting: I am surprised and grateful that the Secretary of State has given way. His position seems to be, “You’ve never had it so good.” People cannot get an appointment to see their GP, they are waiting for ambulances and they cannot get into A&E and be seen within a reasonable period of time, but under this Government patients have apparently never had it so good.

Steve Barclay: As the hon. Gentleman knows, I have been at pains to point to the huge pressure the pandemic has generated, which he seems unwilling to accept.
In Wales, 60,000 people have been on a waiting list for more than two years, which is a huge example of what a Labour Government deliver in practice. Everyone recognises the huge demand for GP appointments, and there is no single solution, but GPs are seeing more people. Forty per cent. of appointments are booked for the same day, and almost 40% of patients have continuity of care.

Paul Bristow: Does my right hon. Friend agree that the £45.6 billion invested in health and social care is a phenomenal investment? The key to addressing the challenge is to make sure the money is spent wisely. If a Labour Government were in charge of making sure the money is spent wisely, with their record of wasting public money, it would be like putting Dracula in charge of the blood bank.

Steve Barclay: My hon. Friend raises an important point. The Government have increased the funding, which will be used in new, innovative ways to deal with the huge challenge we face as a consequence of the pandemic. That is why we have the elective recovery plan, on which we hit our first milestone over the summer in terms of two-year waits. We have rolled out 91 community diagnostic centres, which have delivered more than 2 million tests and scans.
The workforce is, of course, a vital component of this mission, which is why the ambulance workforce has increased by more than 40% since 2010, but we recognise there are significant pressures, particularly as a consequence of delayed discharges, which are having such an impact on the wards and in A&E. That reads across into the challenge of ambulance handover delays.

Margaret Greenwood: I have spoken to nurses who tell me that, when they get to the end of a shift, insufficient staff arrive for the night shift, so they have to hang on. They are working extra hours without being paid because of the shortage of staff. What would the Secretary of State say to them? They are in such a stressful situation. They want to ensure the safety of their patients, but they simply do not have sufficient colleagues to do so.

Steve Barclay: The hon. Lady raises a fair point. Nurses are under huge pressure, and I want to say how much we respect and value the work they do. The pandemic has placed huge strain on the NHS, which manifests in the pressures staff face. I am ready to speak further to trade unions about many of these issues and their impact on staff—there are sometimes concerns about safety and staffing levels—and about how we can have better investment in tech and the NHS estate.
I was up in Liverpool the week before last, and £800 million has gone into the Royal Liverpool Hospital. What a difference that is making to working conditions. We need to see more of that investment elsewhere. A range of things are contributing to the very real pressures staff face, which is why we have committed to investment in capital, both on the estate and in areas such as tech, which can make such a difference to working conditions.

Karin Smyth: Will the Secretary of State give way?

Steve Barclay: The hon. Lady has had a go, so I will make some progress.
The hon. Member for Ilford North says that Labour would free up £3.2 billion by making changes in respect of non-doms—that was raised both at Question Time and in this debate. It will not surprise the House that the Opposition have now spent that money several times on their various pledges. His proposal ignores the fact that we need a tax system that is internationally competitive. His Majesty’s Revenue and Customs figures show that non-dom UK residents are liable to pay more than £6 billion in UK income tax, capital gains tax and national insurance contributions, so the proposal would leave us as a less attractive destination to people who, by their nature, are mobile and can go elsewhere. If they did, we would lose the tax they currently pay into the UK Exchequer.
The hon. Gentleman criticises the Government’s track record on medical training places, but it is worth reminding the House that it was this Government who, in 2018, funded a record 25% increase in medical school places and, in doing so, opened five new medical colleges. Of course, it will take time for that to bear fruit, and the first of those students will shortly enter the foundation programme training. This is an important investment for the long term, and it is why we now have a record number of medical students in training.
The motion covers nursing and midwifery placements. Here, too, we have seen progress, with more than 30,000 students accepting places on courses in England in the last year, a 28% increase compared with 2019. All eligible nursing and midwifery students will receive a non-repayable grant of at least £5,000 per academic year. NHS England has invested £127 million in the NHS maternity workforce and in improving neonatal care, on top of last year’s £95 million investment to fund 1,200 midwife posts and 100 consultant obstetrician posts.
As well as developing talent at home, we must also look to attract talent from abroad. In a motion focused on workforce, it is interesting that there seems to be no mention of recruiting from overseas. People hired from overseas make a fantastic contribution to our NHS, as I hope the House would agree. Unlike the Labour party, the Conservative party recognises the talent that international doctors, nurses and care workers offer, which is why we have been doing more international recruitment. It is interesting that the motion does not seem to welcome that fact, and does not seem keen on more international recruitment.

Wera Hobhouse: Will the Secretary of State give way?

Steve Barclay: The hon. Lady had a go earlier, but I will let her have a final go.

Wera Hobhouse: Yesterday I had a meeting with the Royal College of General Practitioners, which raised the issue of overseas talent wanting to work here and stay here. The Government and the visa system are making that very difficult. The Secretary of State might want to talk to the Royal College of General Practitioners about that point.

Steve Barclay: As part of making things easier, I set up a taskforce in the Department over the summer to look at how we can increase the numbers. We have increased the number of nurses recruited internationally, and care workers are on the shortage occupations list. If there are particular issues that the hon. Lady wishes to highlight, I would be happy to look at them with her, but we are keen to attract talent.

Wes Streeting: For clarity, is it the Secretary of State’s position that we are turning away thousands of talented people who want to study medicine and other health professional courses because we do not need them as we are recruiting from overseas?

Steve Barclay: No, of course not. The hon. Gentleman knows that is not the case. It is a bit like when he goes around the media to charge the Government with refusing to talk to the unions. Simply misrepresenting our position is not a fair reflection of Government policy.
The motion talks about workforce, and this Government have committed to increasing the number of international recruits in the NHS. The Leader of the Opposition seems to think we should not be encouraging that. That is the wider point to make. Of course, that sits alongside domestic recruitment, which is why, as I said a moment ago—again, the hon. Member for Ilford North has chosen to ignore this—we have had a 25% increase in medical undergraduate places, with five new medical  colleges set up by the former Prime Minister, my right hon. Friend the Member for Maidenhead (Mrs May). That underscores this Government’s commitment to increasing the number of doctors in training.

Chris Stephens: The hon. Member for Bath (Wera Hobhouse) raised an important point about problems with the visa process, so will the Secretary of State outline what work he is doing with the Home Office to resolve some of these issues?

Steve Barclay: I discussed this issue with the Home Secretary this week: how we work together across Departments, not just on the visa system, but on other equities. For example, the amount of time spent by police on mental health is an issue of concern to not just the Home Office, but wider government. So there is scope across Departments to work more closely together and we are doing that, both on the issue of international recruitment, which is a key equity within the Department of Health and Social Care, and on mental health pressures on the police, which is an issue within the Home Office. That is how we are working more collaboratively across government, but we are clear that we are boosting the numbers in the short term while, in parallel, increasing the domestic supply of recruits, for example, with the boost in medical undergraduate places. We are also looking at what more we can do in areas such as apprenticeships: how we hire more nursing apprentices and boost supply through that as well.
Finally, the motion does not reflect the pay uplift that was awarded, where the Government accepted in full the recommendation of the independent NHS Pay Review Body. More than 1 million staff have seen an increase of at least £1,400 in their pay. Of course, that comes on top of the 3% rise last year, at a time when pay was frozen across the wider public sector.

Munira Wilson: rose—

Luke Evans: rose—

Steve Barclay: I will give way to the hon. Lady first and then to my hon. Friend.

Munira Wilson: One bit of feedback that my colleagues in outer London constituencies and I have had from health leaders in our area is that the high-cost area supplement, which is available for many inner-London boroughs but is not available for outer London boroughs, is causing huge problems with recruitment and retention. For example, somebody can earn £2,000 more for the same job in Wandsworth than they can in neighbouring Richmond or Merton. Health leaders are calling for a review of the high-cost area supplement, so is that something the Secretary of State is willing to look at?

Steve Barclay: The hon. Lady raises a fair point. That fund has been set up because there is an issue with how recruitment sometimes applies between different areas. We always face the challenge of where one draws that boundary, but I will of course look at specific data on any particular case she wants to raise. The fund is there more widely to recognise that often some areas—

Jamie Stone: rose—

Steve Barclay: I have said that I am going to give way to my hon. Friend the Member for Bosworth (Dr Evans), and then I am going to wrap up. As I was saying, sometimes there are areas where it is more difficult to recruit and we need to look at the data on that.

Luke Evans: When it comes to retention, pensions are a big issue, and the Opposition Front-Bench team have picked up on that. One recommendation from the Select Committee was to mandate for recycling to try to help with that. What other work is being done to try to ensure that senior colleagues with the most experience are incentivised to take on the extra lists and try to deal with the backlog, in all four corners of the country?

Steve Barclay: We are uniquely placed in having a Chancellor who has not only a deep understanding of health issues, but an understanding of recent Health and Social Care Committee reports. Obviously, that is an issue that we, with Treasury colleagues, will keep under review.
The motion ignores the vital work that the Government are doing to back health and care, the £6.6 billion of investment in our NHS that was announced in the autumn statement, and the social care investment of £2.8 billion and £4.7 billion next year. This Government are investing in our health and social care. We have always put the NHS workforce first and we always will.

Chris Stephens: It was noticeable that the Secretary of State talked very little about the workforce in the speech we have just heard, although he spoke about many other things. I want to confine my remarks to the workforce, staff wellbeing and their pay.
Let us recognise, first, the impact on the NHS and staff of not just decisions made in this place on the economy, but of Brexit—that cannot be ignored. For example, the director of the CBI has called on the UK to use immigration to solve worker shortages. The Secretary of State did touch on that, but we really need assurances about the work being done between the Department of Health and Social Care and the Home Office to resolve the many visa issues that the Royal College of GPs had outlined, as other Members have said. According to that research, 17% of international graduates are considering leaving the UK altogether as a result of the challenges they are facing within those visa processes.
Research by the Nuffield Trust has revealed that Brexit has worsened the UK’s acute shortages of doctors in key areas of care and led to more than 4,000 European doctors choosing not to work in the NHS in the UK. Martha McCarey, the lead author of that Nuffield Trust analysis, has said:
“The NHS has struggled to recruit vital specialists…and Brexit looks to be worsening longstanding workforce shortages in some professional groups.”
That has been backed up by a number of organisations that have those very concerns, because the challenges in health and social care are felt in many sectors. What we certainly do not need is some of the right-wing rhetoric  on immigration that we hear in this place, because in many areas of the UK we need more rather than less migration.
Clearly, staff pay is a real concern. In Scotland, we have seen discussions between the Scottish Government and the trade unions; a pay offer is on the table to staff and the trade unions have recommended that the staff accept that latest offer. In England, as an excellent Unison briefing is outlining, we are seeing a number of NHS workers considering leaving the service because they do not believe they should be subjected to a pay rise of 70p an hour. That is a very real concern to them and I believe it is simply not enough—it is not enough when food inflation is at 16%, and we have the high energy costs and housing costs that many people across the country are being subjected to.

Jamie Stone: The hon. Gentleman is making an interesting contribution, and I am thinking about what he has just said about Scotland. The fact remains, as I illustrated in a question earlier today, that the consultant-led maternity service based in Caithness, which has a close connection to his family, was downgraded to its current deplorable state because it could not hire the people. He has just mentioned housing, and I believe that in order to fill the gaps in the most rural areas of the UK we are going to have to offer a more comprehensive package to encourage them, involving housing, something on the mileage rate people are paid and even transport. If we just go down the ordinary route of recruited people from overseas, they will tend to go to the more central parts of the UK, where there is housing and where transport is much easier. We cannot have the rural, faraway corners of the UK left out.

Chris Stephens: The hon. Gentleman knows of my affection for his constituency—many members of my family live there. He raises an important point about rural communities, and in relation not just to the NHS but to the other challenges he outlines. He makes a pertinent point about what all the health services need to consider when applying their services to the areas that he has the privilege of representing, and I thank him for that.
The Secretary of State talked about the autumn statement, but it will not deal with the increasing cost of food and energy, and all the other pressures facing staff. There must be a serious discussion about the NHS workforce, about retention, about giving staff career opportunities and also about wellbeing. I thank NHS staff for what they have done not just during the pandemic, but when I and family members have had health challenges. The work they do and the miracles they perform on a daily basis should be recognised in this place.

Luke Evans: It is worth stressing that point. For all the Daily Mail headlines about the NHS, we must not lose sight of all the good work that goes on unrecognised for the countless thousands of people who go to hospitals, GP surgeries or mental health services and get excellent care. If two patients are on similar pathways but one receives excellent care and the other receives poor care, should not the emphasis be on moving more towards excellent care and less—if not an outright stop—towards poor care?

Chris Stephens: The hon. Gentleman is right; everybody should have excellent care.
As we debate the NHS workforce, we need to recognise what the challenges of the workforce are: whether they are paid adequately and whether there is a real retention strategy. We need to ensure that we have as many staff as we can and that we pay them properly. I did not hear much from the Secretary of State about the state of play of the pay negotiations and what the Government are doing to try to resolve disputes. I see him sighing; he is more than welcome to intervene. [Interruption.] Oh, he was yawning. I am sorry. [Interruption.] Oh, he was not yawning either. He was making a facial expression. I do apologise. We really need a serious debate about pay for public sector workers, and NHS workers in particular.

Richard Foord: When we think about pay for NHS staff, we also need to consider pay for those who work in NHS dentistry. The Government claim to have reformed the NHS dentistry contract earlier this year, but they brought no new money to bear. Does the hon. Gentleman accept that the Government should be measuring not only the number of dentists who are employed to carry out NHS dentistry, but the number of hours that are committed to NHS dentistry? We need to see whether there is a correlation between that and the poor pay that they are receiving for NHS dentistry.

Chris Stephens: The hon. Gentleman makes an excellent point; it is all about pay. What he says about hours is pertinent as well. We know that NHS staff go the extra mile. We know that they work long hours, and we should recognise that. His point about the dentistry service is also important.
As I outlined earlier, the Scottish Government are listening to feedback from the trade unions on pay, and there is a new offer on the table. That means that, in Scotland, porters who are at the top of band 2 will be making £2,502 more a year, nurses or midwives at the top of band 5 will be making £2,431 more, and a paramedic at the top of band 6 will be making £2,698 more. Currently, that is the best deal across the UK, and it is significantly more than the uplift on offer in England—the average value in England is around 4.5%, whereas in Scotland it will be 7.5%.
The Secretary of State also had his usual kick at Wales, but it should be noted that the Welsh Health Minister and the Scottish Health Secretary have written to the UK Government, calling for additional funding this year to support pay deals for NHS staff. I wonder whether, in his response, the Minister will give us an update on the answer to that letter.
I will conclude, because I know that this is a heavily subscribed debate. It is important that we deal with the mental wellbeing of our NHS staff. The Scottish Government have published a wellbeing strategy. We need to show more compassionate and collaborative leadership across the health, social care and social work sectors on these islands. I shall leave it there, Mr Deputy Speaker. The SNP will be supporting the motion submitted by the Labour party today.

Steve Brine: It has been interesting to hear the exchanges between the Front Bench speakers, although I am surprised that there are not more Members  in the Chamber for what is a very important debate. [Interruption.] Actually, where are they on both sides of the House? Given that this is the No. 1 priority of the Opposition, where are they?

Richard Burgon: Is it not the hon. Gentleman’s No. 1 priority?

Steve Brine: Without the heckling from the back row of the Labour Benches, I can say that this has always been my No. 1 priority.
Back in July, the Health and Social Care Committee, which I now chair, published a crucial report entitled, “Workforce: recruitment, training and retention in health and social care”—I urge colleagues across the House to take a look at it, if they have not already done so. We looked at workforce issues right across the NHS, and the findings were stark. The report found that the NHS workforce is facing the biggest challenge in its history. It made the same point about the social care workforce. Although social care is not the focus of today’s debate, it is important to stress, as others have during today’s opening exchanges, that the two sectors are closely intertwined and the workforce problems in the NHS cannot be considered in isolation.
We had NHS Providers before the Select Committee this morning to discuss the industrial action. I asked them whether they support the independent pay review process. I would have intervened on the shadow Secretary of State with that question, but his speech had already gone on for an hour, so I thought he deserved to sit down. More than 1 million NHS workers under Agenda for Change have had, as the Secretary of State said, a £1,400 pay rise this year. That has come out of the independent pay review process. The question I asked NHS Providers this morning, to which the answer was yes, was: do they still believe in the independent pay review process?
Either we have that process, we believe in it and we respect it, or we do not. Are we saying that we have that process and it sticks until something else comes along? If Ministers then become directly involved in negotiating pay for NHS workers, that is a very different proposition. That is not the place we want to be, although the Select Committee is very happy to scrutinise that proposal if it is coming from the Treasury Bench. I would be interested to hear in the winding-up speeches what the Labour party’s position is on the independent pay review process, because it is independent for a reason.
The Committee’s report cited research by the Nuffield Trust suggesting that the NHS in England could be short of 12,000 hospital doctors and more than 50,000 nurses and midwives. The number of people on a waiting list for treatment rose to a record of just over 7 million in September, and the 18-week target for treatment has not been met, as is well known and is on the record, since 2016. Yet, as our report noted, the demand on the sector continues to grow relentlessly. There are estimates that an extra 475,000 jobs will be needed in health by the early part of the next decade.
One of the Committee’s most urgent recommendations was that the Government should do proper workforce planning. We noted that without workforce plans that are independently verified and publicly available, there would be little confidence among the public, the profession or NHS workers themselves that the Government have a grip on the problem.
I must say that the Select Committee has not yet had a Government response to our workforce report—it is a little overdue. The Secretary of State is on the Front Bench, and I know he is busy, but hopefully he will take that back to his officials. We look forward to receiving that response, because it is important that Select Committees get responses to reports in as timely a manner as possible, notwithstanding the fact that there has been a change of Administration.
However, I am encouraged that the Government are paying attention to what the Committee recommended, and I was delighted to hear my predecessor in this role, now Chancellor of the Exchequer, say in his autumn statement that he agreed with himself—his words—and that the Government would now be publishing an independently verified workforce plan for the NHS for the next five, 10 and 15 years, something the Committee has long called for. The Treasury outlined that the plan would
“include measures to make the best use of training to get doctors, nurses and allied health professionals into the workforce, increase workforce productivity and retention.”
Excellent—that is progress.
Questions remain, however—maybe the Minister can touch on this in her winding-up speech—about what the independent workforce planning will look like in practice. We need to know more about who will provide the independent verification once the work has been done. I understand the work has largely been done by the NHS, but we need to know who will be doing the independent verification, when it will be published and how regularly it will be reviewed. When we know that, we will look forward to talking to him or her in the Select Committee.
Our report contained a number of other important and detailed recommendations about how to tackle the NHS workforce crisis. I do not want to go into all of them today—as I have said, the report is on the record and published in the House—but among them I wanted to highlight the radical review of working conditions that was touched on by both the shadow Secretary of State and the Secretary of State.
Work conditions are critical. We talked about the need to reduce the intensity of work felt by so many people in the service—which I hear about both as a constituency MP and as Chair of the Select Committee—and the need to boost retention and of course recruitment of people who are looking at where they might work when they have done training. We recommended that the review should start with an overhaul of flexible working, which would mean that NHS workers were not driven to join agencies or become locums to gain control over their working lives. I often hear those words, “We just need control over our working lives.”
We also said it is a huge problem that senior doctors are being forced to reduce their working contribution to the NHS or to leave it entirely because of the long-standing problem around pension arrangements, which was a problem when I was a Minister in the Department. We accept that the Government have made some progress on pensions, with changes to the taper rate and the annual allowance, and credit to them for that, but we note that the problem persists and have called on the Government in our workforce report to address it.
In that context, to give credit where it is due, I was very pleased to see on Monday that the Government have announced plans to amend NHS pension rules to retain senior doctors and encourage staff to return from retirement. The Secretary of State was slightly mocked when he said that was subject to a consultation, but that is how government works. If the hon. Member for Ilford North (Wes Streeting) were to become Secretary of State—I like him very much, but I hope he does not—he would also publish consultations, because that is how proper government is done, and he knows that. We look forward to seeing the Government response to that consultation, which I know the Secretary of State is keeping a keen eye on
The Secretary of State is right to say that there are a record number of doctors in training, with five new medical schools, two of them focused on training GPs. That is true, but the Select Committee will return to our workforce work next year, and we will be taking evidence from anyone who wishes to contribute about the cap on training places. I have said to Ministers and to No. 10 that I think the Government are going to have to look again at that issue. I hear in my constituency from bright young boys and girls who wish to train as medics, whose parents have maybe worked in the profession and who have that ambition for themselves. The cap is a problem.
My other point is about demand. We had somebody from the British Medical Association’s GP committee before the Select Committee this morning, as part of our ongoing inquiry into integrated care systems, who was talking about the NHS being underfunded. That depends on which end of the lens we look at, does it not? We spend £150 billion or so of taxpayers’ money on the NHS. We could spend £300 million; that would be a choice. We would have to fund it, of course, because we know what happens when people make unfunded spending pledges from the Dispatch Box—the markets go into meltdown, and rightly so.
We need to have a serious and honest conversation with ourselves about how much of our national wealth we wish to spend on our health service and whether that would achieve the desired outcomes. We are the fifth-largest spender on health services in the OECD, but we do not get the fifth-best outcomes. I can give the House a bit of an exclusive here, because in the new year the Select Committee will be launching a big inquiry into prevention. Anyone who knew me when I stood at the Dispatch Box as a Minister will know that cancer and prevention are the two things that most get me out of bed in the morning, so we will do a big piece of work on prevention.
My view and the view of many others is that the NHS will have long-term sustainability challenges if we do not get serious about prevention. I do not just mean returning to the argument around obesity and all the things I wrote about in the child obesity plan when I was a Health Minister, although they are important and I urge the Government not to backtrack on any of those policies but to implement them, because weight is a major problem in our ill health. We need to get upstream of ill health.
I will say more about this in the debate in the House on Thursday, but when the Committee returns to cancer work, we must look at future cancer and at getting upstream of cancers. At the moment, we want to diagnose quickly, but people have to have symptoms in order to  be diagnosed quickly and then we need to treat very quickly as well, within the 28-day standard. The Secretary of State and I have talked several times already about how we need to get far ahead of that.
We need to bring together predictive medicines, biomarkers and some of the life sciences work that is going on with the NHS’s genomic strategy, and get ahead of some of the illnesses that drive ill health in our country. Without that, in my humble opinion, the NHS has long-term sustainability problems.

Emma Hardy: This is a perfect point for me to lobby the hon. Gentleman on also looking into diagnosis times for people with endometriosis, who are waiting on average seven and a half years to receive a diagnosis, and women’s health treatment generally. That would be a wonderful inquiry for his Select Committee to look into and take under observation.

Steve Brine: Duly lobbied, thank you. The hon. Lady has mentioned this to me many times before; I take the point on board and other members of the Committee in the Chamber will have heard her too.
In all the work that we are doing on the Select Committee, whether on ICSs, prevention or cancer, or the work done by my predecessor chairing the Committee, workforce is without question the common theme that runs through all of that. We cannot get away from that. I think there are encouraging signs that the Government are listening to the Committee, and of course we have a great advocate in No. 11 Downing Street and in the Secretary of State, who I was pleased to see reappointed to his position.
I urge the Government to continue to listen to the Select Committee. We are a cross-party Committee, looking at things in a sober, calm, evidence-based way, and we look forward to the Secretary of State coming to see us soon to talk about these issues. The invitation is always there, as he knows.
The workforce challenges that the NHS faces are the bottom line. Without tackling them, we are not going to move forward on many of the challenges that I know the system has. I welcome this debate; I hope we can keep it sober, keep the party politics out of it and focus on the NHS, because ultimately that is what our constituents demand of us.

Lyn Brown: Across north-east London, our population is set to grow by the total of the population of Dover in just the next five years. By 2042, the added population will be the size of Milton Keynes. We have the highest rate of NHS vacancies in London. We simply cannot go on without long-term workforce planning and investment in staff and in services. We have lost a large number of international staff since Brexit, and retention is a massive problem, with an annual staff turnover of almost 17% in the Government’s recruitment campaign for nurses.
We have the highest spend on agency staff in the region—10% of some staffing budgets goes to agencies. But even with all that money being spent, our operating theatres are struggling to find enough bank and agency staff to fill the gaps. How on earth are we going to tackle the backlog if our theatres cannot be used to full capacity? How are we going to get patients in and out of hospital quickly if their operations are being delayed?
In Newham, maternity is one of the worst affected NHS services. As we know, high-quality accessible maternity care saves lives, and local need is massive. We have very high levels of poverty, as well as demographic pressures from our rapid population growth. There is a 19% vacancy rate on our maternity wards; almost a fifth of roles have no one to do the job, so non-specialist nurses are filling in for midwives. Surely, that has an impact on the quality of care. Sometimes, even women who have been assessed as having a higher risk cannot be admitted because there are, frankly, not enough fully staffed beds, so they are sent home instead, with an obvious increased risk.
One of our birth units is being closed repeatedly so that staff can transfer elsewhere and keep hospital services running. Those forced closures took place for almost 10% of the year to August. Surely, that increases costs for the NHS, as lower-risk births end up having to take place in hospital.
Every part of the NHS is creaking, and we are getting closer to collapse because workforce issues have been neglected. We have known that these problems have been getting worse for years now, exacerbated by austerity. This ain’t just about midwives and doctors; there is a shortage of admin staff, too, which is leading to a higher number of antenatal appointments being missed. So, when patients have to go into hospital even though they could be treated more effectively in less expensive settings, and when appointments are missed and preventive care does not take place, what happens? Costs go up for our NHS. The Government’s failure to recruit and retain enough staff is making our NHS less effective in terms of value for public money and is, let us face it, putting lives at risk, too.
In north-east London, we have the most diverse integrated care system population and the highest birth rate in the country. We know that if maternity patients do not get the care that they need, the risks are high. We have all heard the terrible statistics about women from black communities being four times more likely to die in childbirth than women from white communities. If we are to address that shameful injustice and end those deaths, Newham is one of our frontlines. But the reality is that our response is being held back and women put in greater danger because our NHS simply does not have the staff. The Government need to understand that many of those difficulties could get even worse without change. As we know, so many of our health and care staff are simply exhausted. They are working all the harder to fill in for vacancies. Often, they are offered less flexible work because the demand on services is so acute and no one can fill in the gaps.
A decade of austerity and the cost of living crisis have taken a huge toll. Locally, 17% of our skilled and experienced nursing staff are over 55. Many of those who keep our services going—or barely running—do not have many working years left in them. We can see that this is completely and utterly unsustainable. The dedication of our NHS staff, for which we rightly praised them so highly during the pandemic, has its limits. How much closer to collapse will our NHS get if these pressures continue to build? How many more patients will be let down? Frankly, a Labour Government cannot come soon enough.

Paul Bristow: I refer Members to my entry in the Register of Members’ Financial Interests. It is a great honour to follow the hon. Member for West Ham (Ms Brown), who I thought spoke very movingly about the challenges faced by communities in her constituency. West Ham is not a million miles away from Peterborough, and I recognise some of the challenges that she identified, especially the horrible disparity between black women giving birth and their white counterparts—that is a stark statistic. She spoke passionately about that, and I think we would all recognise it—especially me, as a father of two young daughters.
In one of my first speeches as a Member of this House, I stood here and spoke about our NHS as someone who had worked in healthcare and public policy on and off for 20 years. I said that every two or three years, politicians stand up and say that the NHS needs more money, more capacity and a plan. When I made that speech—about three years ago now—I said that we cannot have another situation whereby we stand in the House asking again for more money, more capacity and a plan. Ultimately, that is exactly what we are doing. And so it goes on.
I understand that we have had a covid pandemic in the meantime; I understand that we have to recover from something that was extraordinary. But we have to make sure that the NHS is able to make the most of the budgets that it has. We have listened to quite a few contributions from the Labour party, including that of the shadow Secretary of State, the hon. Member for Ilford North (Wes Streeting). I cannot quite be sure whether he was asking for more money or saying that the investment in our NHS was not enough. As a result of the covid pandemic, the Government are putting an extra £45.6 billion of investment into healthcare. That is an extraordinary amount of money.
Indeed, the Institute for Fiscal Studies says that by 2024, healthcare will account for 44% of day-to-day Government spending. I understand that that does not include capital funding, but that 44% of day-to-day Government spending leaves just 56% for everything else—that is an extraordinary statistic. We have to make sure that we get value for money out of the money going in. Yes, we have the £44.6 billion that is going in, but another £3.7 billion is also being spent on capacity. What does that say to us? It says that we need to increase productivity in our NHS and get the most out of the money that we are putting in.
The King’s Fund has found relatively recently that the annual average growth in productivity in our NHS increased from 0.7% in the 1980s to only 1.2% by 2012-13, and we need to do much better. When I say “we”, I am talking not about the individuals working for our NHS—doctors, nurses, allied health professionals; people on the ground—I am talking about the system as a whole. We need to do much better, and I want to suggest a few things that may help.
The first is ensuring that clinicians and those working in our NHS operate and practise at the top of their licences, and that we make better use of other healthcare professionals, such as nurse practitioners, and of things that have been around for a long time, such as nurse-led prescribing. Why does my wife, if she does not want another child and she wants to take contraception  seriously and go back on the pill, need to have that prescribed by a GP? That does not need to be done by a doctor; it could easily be done by a pharmacist or at least a nurse in a practice. That does not require a face-to-face GP appointment, especially when we have shortages of GP appointments.
Some GP practices are doing fantastic work. I refer to the Thistlemoor surgery, which I have mentioned in this House on a number of occasions. I think that Dr Neil Modha and everyone who works there would be embarrassed by the number of occasions I talk about them in this place. That GP surgery serves up to 35,000 people in my constituency, of whom 80% do not have English as a first language. Those there pride themselves that if someone turns up who was unable to get a face-to-face appointment by ringing up, they will do everything they can to see that person on the day, and in the vast majority of cases that happens. How do they do it, with such a huge demographic challenge with the number of people who do not have English as a first language? They do it through effective use of admin staff. They have a number of people who work in the admin department in triaging who speak a variety of different languages from the communities that the surgery represents. By the time the patient is with the GP or relevant healthcare professional, they already know pretty much everything about the patient, what symptoms they are presenting with and what might be done to help them. It is an excellent surgery doing excellent things in my city.
I also want to talk about surgical and cath lab capacity. Perhaps I am naive, but we seem to spend lots of money to create that capacity in our NHS, yet for a significant period of time, it is just not being used. We are increasing the productivity of those places by making sure that they operate throughout the day, and in certain cases throughout the night, but a consultant I spoke to relatively recently said that it was still very common for consultants to operate only one day a week in cath labs. I understand that they have lots of important things they need to be doing with their time, including training the people of tomorrow, and that being a surgical consultant is not just about surgery time, but goodness me we need to be doing a lot better than one day a week. We need them to be treating patients, powering through lists and doing what they need to do.
A lot of this is about investing in innovation, too. Lots of procedures, such as nurse-led endoscopy, do not necessarily need to be done by a consultant at the top of their game. We need to be investing in systems and technologies that allow us to have more day cases, rather than more expensive in-patient services. This all seems like common sense, but the same debate about increasing productivity has been going on for about 20 years in the NHS, and these are some of the arguments I have been making for a number of years, not just inside this House, but outside it.
I also want to talk about pharmacy. During the pandemic, pharmacy was often the only visible sign of the NHS on our high street. It is right that we make more effective use of pharmacy and pharmacists. I speak to pharmacists in my constituency, and they want to do more. They did so much during the pandemic, particularly with vaccinations, and they can do so much more. My plea is to use our pharmacies as much as we possibly can.
Another issue I want to raise while I have the House’s attention is that we spend a lot of money on organisations such as the National Institute for Health and Care Excellence and Getting It Right First Time. We put a lot of responsibility in the hands of doctors, clinicians, patient organisations and all those involved in creating policies, commissioning policies, service specification and all the rest of it, but often we then go away and ignore them. I do not understand why we do that. GIRFT identifies sensible ways that the NHS can save money and get better outcomes for patients, but most of the time that is not replicated across the system, and I just do not understand why. Of course local decision making is important, but if something works in Peterborough, it will work in Torquay. We can certainly increase productivity, patient outcomes and save money by doing the things that those organisations tell us to do.
Similarly, we do not quite have the 24/7, seven days a week NHS system that many of us would want. There are far too many elements of our NHS that only seem to operate between 9 and 5 on weekdays. Unfortunately, when someone presents with a serious episode, such as myocardial infarction, stroke or whatever, they will not wait until 9 o’clock on a Monday morning to get the most appropriate treatment. We need a system that is truly 24/7, 365 days a year.
I pay tribute to what my hon. Friend the Member for Winchester (Steve Brine) said about prevention, which was spot on. A lot of the things I have talked about on increasing productivity relate to treatment within the NHS itself, whether in an acute or primary care setting, but if we are to make significant productivity or value for money savings in the NHS, we need to stop people presenting at hospital when they do not need to. A lot of that will be achieved by people looking after themselves and having the information available to them, through investment in public health. I asked today in the Health and Social Care Committee whether these integrated care systems looked like a true partnership among public health, primary care, acute care and social care. The jury is still out on that one, but we definitely need significant investment in prevention, and I am looking forward to taking part in that inquiry.
I end with this. I have talked a little about what I think needs to happen, and I have done it rather constructively, I hope Members from all parts of the House agree. Despite the fact that there are probably severe differences between both sides of this House, all of us want a national health service and systems in place that are working as they should be, and all of us want to see a fully funded, appropriately funded and appropriately staffed national health service. Significant progress has been made: the Chancellor of the Exchequer, my right hon. Friend the Member for South West Surrey (Jeremy Hunt), who was previously Chair of the Health and Social Care Committee, has said that he will accept the idea of an official workforce target being put in place. That is a huge step forward.
Some significant gains, and investment, have been made in our NHS. The number of people working in our NHS is going up. With a little consensus about the solutions we need for our national health service, such as those that I have suggested, we can ensure that it goes on and prospers.

Nigel Evans: As there are only people on the Opposition Benches remaining to speak, I will try to do without a time limit. That may be hope over expectation, but none the less, if people stick to around about seven minutes, that should be okay, because we will be starting the wind-ups no later than ten-past 4, with any anticipated vote at about half-past 4.

Taiwo Owatemi: Many Members will remember that the Health and Social Care Committee recently published a report on the NHS workforce—a report that the Government frustratingly chose to ignore. As workforce shortages stand at unprecedented levels right across the NHS, with the latest figures revealing that there are more than 133,000 vacancies in England alone, I thought it might be useful to remind the Government of some of the report’s key recommendations.
First, the Government are failing to provide our NHS nurses with the essentials that anyone would need to do their job properly. In short, they are serving up poor working conditions, year in, year out. At the bare minimum, all nurses across the NHS should have easy access to hot food and drink, free parking or easy access to work and spaces to rest, shower and change, but the Government cannot even get that right.
I have repeatedly raised with the Department of Health and Social Care and the Prime Minister the fact that NHS staff at Coventry’s University Hospital are paying an astronomical £600 per year simply to park at work. In the middle of a cost of living crisis, it is outrageous that Coventry’s NHS heroes are out of pocket because the Government choose to do vanishingly little to improve their situation. I again call upon the Department of Health and Social Care to look closely at this situation and scrap these unfair parking charges for good.
Is it really any surprise that the Government’s current target of recruiting 50,000 nurses has been woefully missed when they are treated so poorly? It is unacceptable that many NHS nurses are struggling to feed their families, pay their rent and heat their homes. Some nurses are even resorting to using food banks this winter. I urge the Government to look closely at how they can better pay and treat NHS staff this year and next, so that we can finally reverse this worrying trend.
Our beloved NHS, which I had the honour of working for as a senior cancer pharmacist before being elected, is on its knees as a result of 12 years of Conservative neglect and mismanagement. Many services are crumbling. Pay has failed to keep up for years, and morale among nurses is in a truly terrible place. That is exactly why the Royal College of Nursing has been pushed into taking industrial action this month and why the Government must stop the mud-slinging and instead work with nurses to resolve this crisis.
Secondly, the Government must take urgent action to improve maternity care. For over a decade, the Conservatives have failed midwives across my community, and now we are all paying the price. We need a robust, fully funded maternity workforce plan, and the Government must commit to recruiting and retaining the workforce at the level set out in the forthcoming report by the Royal  College of Obstetricians and Gynaecologists. Labour has made it crystal clear that we would train at least 10,000 additional nurses and midwives each year to tackle the crisis that currently exists in maternity care. Labour has also committed to a historic expansion of the NHS workforce, to plug the gaps created by this Government.
The Government must also improve diversity in the recruitment of midwives, to improve the standard of care that black, Asian, mixed-race and minority ethnic women receive throughout pregnancy, birth and the post-natal period. By increasing diversity across the NHS, we can guarantee better standards of care for everyone, regardless of their background or ethnicity. Labour’s women and equalities team has routinely pushed for reforms that would improve how everyone experiences healthcare in this country, so when will the Government catch up?
Lastly, as the newly elected chair of the all-party parliamentary pharmacy group, I want to highlight an opportunity that the Government have failed to grasp: better use of community pharmacists. As a trained pharmacist, I know that the sector is crying out for more responsibilities to become the first port of call for patients who need advice and treatment. That would help to rebalance the workload across primary care, bring healthcare back into the community, reduce the pressures on GPs and hospitals and deliver healthcare that is much more prevention focused.
Any plan for the future of pharmacy must ensure that all pharmacists have adequate access to supervision and training, along with clear structures for professional career development into advanced and consultant-level practice to help to deliver this. That way, community pharmacists can play a much larger and more effective role in delivering healthcare. Until this Government properly mobilise pharmacies, we will struggle to reduce waiting times, clear NHS backlogs or improve patient access to GPs, so I desperately want to see action here. Every Member here today understands that our NHS workforce faces a range of big challenges. Whether it is nurses, midwives or pharmacists, our NHS workforce are at breaking point.

Paul Bristow: I completely share the hon. Lady’s sentiments about making better use of community pharmacists. She talked about better support and resources being available for pharmacists to do just that, but what specific things does she think need to happen to get the ball rolling?

Taiwo Owatemi: That is an excellent question. I could be here for hours explaining what I would like to see, but essentially, what I and many in the profession would like to see is an understanding and full use of the various skills that pharmacists have. We talked about this in the Health and Social Care Committee today: I would like pharmacists to be involved in providing clinical care—for example, a diabetes workshop or a cardio blood pressure workshop. We have seen other countries do that. In Alberta, Canada, community pharmacists are involved in the whole of the hypertension management; it is taken away from GPs and brought into the community, because it is more accessible in a community pharmacy.
Whether it is nurses, midwives or pharmacists, our NHS workforce are at breaking point, but the Government are seemingly ignoring that. I hope that the Government urgently sit up, take note and look at how they plan to address our workforce needs, to ensure that our beloved NHS staff are no longer ignored.

Sam Tarry: For the first time in its 106-year history, the Royal College of Nursing has taken the monumental decision to take strike action. They have not taken that decision lightly, because no worker does, but this Government have pushed them to the brink. Ministers have had weeks to find a resolution, but they have rejected all offers of formal negotiations. As the RCN said, all meetings with the Government have seen Ministers sidestep the serious issues of NHS pay and patient safety. Do not be mistaken: they have the power and the responsibility to address this dispute, but they choose not to for self-serving political gains. They have seen that workers in rail, the Royal Mail, BT, universities and across the public and private sectors are now prepared to fight back because they are so sick of what this Government have been doing. They know full well that these disputes will have to end in pay rises for the workers of this country.
These are not the days of the miners’ strikes when the mines could just be closed because they were not needed any more. We are always going to need hospitals, we are always going to need railways, we are always going to need schools and we are always going to need universities. People are beginning to fight back and stand up, and it is time that the Government listened very carefully, especially in their so-called red wall seats.
At the height of the pandemic, every Thursday night the Prime Minister, the Health Secretary and Members across the House clapped for our NHS heroes and praised their immense effort on the frontline of the pandemic, but clapping does not pay a single bill. This dispute has highlighted the total hypocrisy at the heart of this Government. Once praised as heroes, nurses are now treated dreadfully. Ministers have sought to ratchet up the rhetoric, with the right hon. Member for Stratford-on-Avon (Nadhim Zahawi) seemingly seeking to present NHS workers as hostile agents of a foreign power, ludicrously and disgracefully dismissing industrial action as “helping Putin.” Get real! These are nurses, not agents of a foreign power. The Health Secretary has said that pay demands are “neither reasonable nor affordable”, while utterly refusing to engage with nurses’ unions over their demands, only offering a paltry 3% pay rise when inflation is well above 11%. According to The Times, instead of looking for a resolution to this dispute,
“Ministers plan to wait for public sentiment to turn against striking nurses as the toll of disruption mounts over the winter”.

Anthony Browne: The hon. Gentleman talked about the difference between the pay offer and inflation. If all public sector workers were given a pay rise in line with inflation, it would cost the equivalent of a 4.5p rise in the basic rate of income tax. Does he support that, or would he pay for such big pay rises in other ways?

Sam Tarry: Our Front-Bench team have clearly set out a number of proposals, including taxing non-doms, which would seek to address the lack of funding in our NHS. I will not get into the specifics, but putting money into the pockets of ordinary people will clearly bring more revenue into the Treasury. The truth is that nurses have not had a real pay rise for more than a decade. The most experienced frontline nurses are now £10,000 a year worse off in real terms than in 2008, effectively meaning that they are working one day a week free of charge—how many days does the hon. Gentleman work free of charge?

Carla Lockhart: The hon. Gentleman is making a powerful point about nurses. He will be aware that their role has evolved significantly and they are often now asked to do more training and more work on the same pay. Does he agree that it is unfair to demand more while paying the same?

Sam Tarry: Absolutely. My little sister is a nurse who works in palliative care in Southend, Essex. During the pandemic, her job was to help lots of people to experience the least suffering as they met the end of their life. The mental health of nurses has been broken, there is increased stress, and bank staff are being used—all as a result of nurses being so devalued that the Government have taken away their bursaries. We have a huge crisis, but one obvious fix would be to sort that out. Of course I agree that we have to listen and value our nurses.

Paul Bristow: Will the hon. Gentleman give way?

Sam Tarry: I will make some headway, because plenty of other hon. Members want to speak.
It is not just about pay: workforce shortages are at unprecedented levels across the NHS. The latest figures reveal that there are now more than 133,000 vacancies in England alone—more than a third of which are in nursing—which is an all-time high and a record for this country under the Government. The vacancy rate in registered nursing is running at nearly 12%, which is an increase from 10.5% in the same period of the previous year. A key factor in the failure to attract and retain enough staff is the Government’s inability to provide workers with a decent pay rise. Some 68% of trusts report that staff are leaving for better terms and conditions elsewhere.

Paul Bristow: The hon. Gentleman spoke about nurses’ pay and how they deserve more. We would all like to give nurses more money, but how does he account for the fact that the Welsh Labour Government are giving exactly the same pay award as proposed by this Government?

Sam Tarry: I cannot speak for the Welsh Government, but if we look at their record—the times that they have been returned to office with a stonking majority, and the fact that there are no strikes on their railways, which they had the guts to take into public ownership; they called it what it was—I would much rather be living under them than the appalling Government we have.
The impact of those shortages on existing staff is enormous. Reports by Unison have repeatedly highlighted the acute strain that understaffing has put on the workforce,  with stress and burnout rife among NHS staff. That predates covid, which demonstrates the immense damage done by a decade or more of Conservative Governments and the failure of successive Governments and Prime Ministers to invest in the workforce or take workforce planning seriously. As the RCN has said, the dispute is about not just pay, but patient safety, which is key for all of us. Staffing levels are so low that patient care is being compromised; only paying nursing staff fairly will bring the NHS to a point where it can recruit and retain people to address those issues.
I have visited my local hospital, King George Hospital, on many occasions and I have heard about the impact of staff shortages and pay cuts on staff and patients alike. Recently, for once, I went to open some new services in paediatric emergency and radiology—something positive after 20 years of campaigning for our local NHS in Ilford—yet the staff were still overstretched, run ragged and demoralised. They just want the support that they need to care for their patients, which means pay recognition and ensuring fair practices at work without undermining their working conditions.
I spoke to staff who, during the worst of the pandemic, received food donations from the local community just to get by. That should never, ever be allowed to happen and makes it even more sickening to hear about the outright corruption on the other side of this House and the despicable corrupt PPE deals with people like Baroness Mone. People in Ilford are sick and tired of that because of the attacks on our local services. We even had to stand up and campaign for our local ambulance station not to be shut down under the Government’s measures.
Conservative Members seek to present nurses’ demands as unreasonable and undeliverable, and have asked nurses to tighten their belts even further, while they have allowed the pay of the wealthy to explode. This year, FTSE 100 CEOs collected an average of 109 times the pay of ordinary workers—that is part of the answer to where we get the money to pay the people who actually keep our country off its knees. Where is the Government’s commitment to pay restraint when it comes to high pay and those sorts of people? How many Conservative Members have fat cat salaries and executive directorships, and coin it in left, right and centre?

Anthony Mangnall: You all have second jobs!

Sam Tarry: I do not think a single person sitting on the Opposition Benches has a second job.
The truth is that NHS staff pay demands are reasonable and fair. Nurses’ pay is down by £4,300 and paramedics’ pay is down by £5,600. One in three nurses cannot afford to heat their homes or feed their families. NHS staff are at breaking point. When I met NHS Unite members from Guy’s and St Thomas’s Hospitals—I welcome any hon. Member to come with me and speak to them, because they are just across the river from this House—they were justifiably furious about the way that for too long, they and their colleagues have been exploited and abused by the Government, as they see it.
Staff are the backbone of the NHS, and if they break, so does the NHS. As the RCN general secretary said:
“Nursing staff have had enough of being taken for granted, enough of low pay and unsafe staffing levels, enough of not being able to give our patients the care they deserve.”
Allowing the NHS to collapse will cost the country considerably more, financially and in national wellbeing—as we are already seeing on the Government’s watch—than the rightful pay demands of NHS staff. If our NHS is not providing the care that we need, the costs are far greater, as is economically demonstrable.
Many hon. Members on both sides of the House believe that the NHS is our greatest institution. We cannot take it for granted and it is well worth fighting for. Conservative Members have the power to stop this dispute; to sit down with the trade unions; to face the nurses and NHS staff; and to negotiate a fair deal to prevent misery, ensure patient safety and save the NHS. If the Government will not do it, they should resign now, because a Labour Government will save the NHS and support NHS staff.

Taiwo Owatemi: On a point of order, Mr Deputy Speaker. I want to put on the record that my mum is a practising nurse.

Nigel Evans: I think we would all be proud to make that declaration, which stands on the record. We must now look to a speaking time of six minutes or thereabouts, or less if you can, to give everybody fair time. Please focus and, if you take interventions, do not add time on mentally.

Emma Hardy: In Hull West and Hessle, 1,730 people are waiting more than 28 days to see a GP and 6,225 are waiting more than 14 days. The ratio of GPs to patients in Hull is one of the lowest in the country, which is fuelling some of the many problems that we are seeing in accident and emergency. That is combined with the concerns that I raised with the Secretary of State about the delay to discharge; the 30% vacancies in our adult healthcare sector; and the delay in money that the Government promised to adult healthcare services, which means that delays are only increasing. I am incredibly concerned about what will happen over the winter.
I will focus my remarks on my concerns about radiotherapy, about which I have written to the Minister of State, Department of Health and Social Care, the hon. Member for Faversham and Mid Kent (Helen Whately). With respect, I wrote to her on 3 September and received a reply on 28 November, which is disappointing on such a serious matter. I raise that issue today because, in August, I received an update from the Humber and North Yorkshire cancer alliance about the state of radiotherapy. For those who are unfamiliar, radiotherapy is used to treat and kill cancer cells and to shrink tumours. It is often used in the early stages of cancer.
In the briefing note that the Humber and North Yorkshire cancer alliance sent me, which I can only assume it sent to other Members of Parliament, it says:
“It is expected that the radiotherapy position at HUTH will worsen through the year. The reduced capacity obviously could pose a risk to patients (from a health and wellbeing perspective, as well as from a patient experience perspective).”
The reason it wrote to me to tell me of its concerns about radiotherapy is the shortages we have in the area. It says that the percentage of Hull University Teaching Hospitals NHS Trust patients who began radiotherapy as their first definitive treatment for cancer and who did so within 62 days of an urgent referral for suspected cancer—within 62 days of an urgent referral—was 22% in July, 50% in June and 29% in May, compared with over 50% previously. The percentage of HUTH patients who received radiotherapy following their first definitive treatment within the 31-day target was 44%. So the majority of people are not being seen for their cancer treatment within the 31-day target, and only 22% of people sent for urgent referrals for suspected cancer are being seen.
The reason for this is given in the briefing note, which says:
“Many of HUTH’s therapeutic radiographers have left the profession to pursue a better work-life balance, while those who have remained in their roles have also sought improved work-life balance by seeking roles closer to where they live to reduce commute times.”
That is the reason people are leaving—to seek a better work-life balance. It is not because they do not care or they do not wish to continue to treat people, but because they simply cannot maintain it at this level. The note says that
“staffing shortages is an issue experienced across the country.”
It also says—this is a key point because the Government’s defence is often that the pandemic has caused all these problems:
“Therapeutic radiography has been considered a vulnerable profession for years.”
Pre-pandemic we were having problems with radiographers, but no action was taken, and this is still considered a problem right now.
I wrote to the Minister and the Secretary of State about this, quoting from the briefing note. I sent the letter on 3 September, and I said:
“I am sure you will agree that the evidently increased waiting time for potential life-saving or life-prolonging treatment is extremely concerning.”
I understand that Hull University Teaching Hospitals NHS Trust is doing everything it possibly can. It has taken on two apprentices to be trained up as radiographers, but we all understand that we cannot instantly produce the radiographers we need. As I say, I sent the letter on 3 September, and it was also signed by my right hon. Friend the Member for Kingston upon Hull North (Dame Diana Johnson) and my hon. Friend the Member for Kingston upon Hull East (Karl Turner). It took the Minister until 28 November to reply, even though I started the letter by saying:
“I am writing having received a very worrying update from the Humber and North Yorkshire Cancer Alliance regarding a reduction in services”
in my constituency.
In her reply, the Minister admitted:
“HUTH advises that, to protect existing staff and maintain the service, it was necessary to reduce capacity to sustainable levels, which has in turn led to the inability to reach specific targets and a growing waiting list.”
So this is a problem that the Government are well aware of, despite their delay in responding to it. It is a problem that has been around for years, and it is a problem that  is literally a matter of life and death. If people do not get the cancer treatment they need when they need it, we know the consequences. The failure to deal with and address the NHS workforce is not just a mild inconvenience; it is an incredibly serious matter that has been a long time coming and a damning indictment of 12 years of Conservative mismanagement of our NHS.

Bell Ribeiro-Addy: The importance of this debate should not be understated because the NHS is in a dire state, and that is largely the result of a severe staffing crisis. Other than the generally inept economic policies we have seen from the Government, there is no denying that the Brexit deal has had a direct impact on staffing numbers, and that chronically low pay and poor working conditions have resulted in an exodus of staff leaving the NHS to work in the private sector, work abroad or leave the healthcare profession entirely.
I would like to start with one of the most undervalued groups in our NHS, which is the first that most of us meet in modern Britain—the midwife. The Royal College of Midwives has estimated that it has an existing and long-standing shortage of more than 2,000 midwives, and that for every 30 who are trained, NHS England loses 29. Vacancies for nurse positions are estimated to be at an all-time high, with a survey at the start of the year finding that 57% of nursing staff across healthcare settings are thinking about quitting or actively planning to quit their jobs.
With figures such as these, we cannot blame existing staff for wanting to leave or blame others for not wanting to fill these vacancies, particularly when we see the TUC’s estimates that, since the Conservatives took office in 2010, midwives have had a total real-terms pay cut of £5,657, nurses’ pay is down by £4,310 in real terms and the pay of all doctors is down by about 7.4%. We cannot forget the thousands of non-medical staff, who are often overlooked, but are integral to keeping the NHS running. Cleaners, security guards, porters and other important workers have, along with other NHS staff, faced real-terms cuts in pay since 2010.
Is it any wonder that the NHS waiting list has now tipped to over 7 million? When we hear of the scale of the vacancies, can we really be surprised that some A&E patients are left waiting for over 12 hours, or that ambulances are repeatedly failing to meet their target response times? The staffing crisis in the NHS is having a dire impact on patient safety, and if we are going to tackle the NHS backlog, address the crisis in staff recruitment and retention, and bring the NHS back to the standard it should be, we first and foremost have to address pay. We cannot be gaslighting nurses by saying that they should drop their pay demands to send a message to Putin, which is absolutely ridiculous.
We have to pay nurses what they are worth, and if the Government were not aware of what they are worth, the pandemic should have shown them. We called them key workers because we could not do without them, yet the Government justify their pay by calling them low-skilled workers. There is no such thing as low-skilled work; there is only low-paid work. All work is skilled when it is done well, and our NHS staff are the best example of this. On the contrary, Ministers, who are paid multiple  times more but who have shown little skill in running the country, if the cost of living crisis and the economic situation are anything to go by, are completely different. They get paid so much more, but we cannot see their sense of skill in running this country.
In the past year, a number of NHS personnel have been taking strike action against low pay, and nurses will be striking later this month for the first time in the Royal College of Nursing’s 106-year history, while ambulance staff have announced their strike today. If that does not show us the scale of the crisis facing workers in the NHS, I do not know what does. No one wants to have to take strike action, least of all the workers in our NHS, but the dire situation of chronic underpayment and poor conditions is leaving them no choice. This Government have left them no choice. When we have 27% of NHS trusts operating food banks for their staff, when one in three nurses is taking out a loan to feed their family and when NHS staff across the board are severely underpaid, of course they are at the point of saying that enough is enough.
No one goes to work for the NHS for the money, but it cannot be fair to expect people to live on poverty wages. If the Government want to address this crisis in recruitment and retention, they must get over this ideological aversion to paying public sector workers what they are worth. That means committing to a proper cost of living pay rise, and setting out plans to reverse a decade of real-term cuts in pay for our NHS workers.

Daisy Cooper: Let us imagine what this debate could have been. If the former Prime Minister—the former former Prime Minister, I should say—had accepted the workforce amendment to the Health and Care Bill 13 months ago, this debate could have been so different. The Government could have crunched the numbers, NHS frontline workers would know that the cavalry was coming, and patients would be able to see light at the end of the tunnel. Instead, here we are as Members of Parliament with a roll-call of horror stories, because somehow, in 2022, waiting more than 12 hours for an ambulance is the new normal. How on earth has it come to this?
We know that there are workforce problems in every part of our health and social care sector and every corner of our country, whether general practice, dentistry, pharmacies, midwifery, nursing—all are overstretched and understaffed. But it is midwives who send me their most distressed emails, because they often train for their dream job, only to be plagued by nightmares that they have not done enough to help new mothers and their babies in their time of need.
Just last week I spoke with paramedics and other ambulance staff as I took a three-hour ride out with my local ambulance service. At 7 o’clock in the morning we were called to see the first patient. That patient had been waiting at home, on the floor, since 6 pm the night before—13 hours. Before we could get to see that patient, we were called to a more urgent call. When we finally got to the hospital with that second patient, the paramedics checked the list of patients who had arrived at the hospital. They were distressed that they had not been able to get to that first call, and wanted to make sure  that another ambulance had done so. They were exhausted. They said that in a 12-hour shift they may get only one 20-minute break. They were exhausted because there are not enough staff.
For most of my constituents, day in, day out, access to their GP really matters, and too many of them are struggling. That is no wonder, because the Government said they had a target of recruiting 6,000 more GPs, but they have admitted within three years that they will fail to meet that target. It is frustrating for patients, but it is also dangerous for GPs and their staff. This summer we heard reports from Walton-on-Thames in Surrey, where police had been called to a GP surgery because people were making threats of physical violence. That is surely unacceptable. Where is the urgent drive to recruit and retain our GPs?
How on earth will we retain and motivate highly trained professionals when our hospitals are on the verge of collapse? Up and down the country there are hospitals in dire need of repair. In Eastbourne—I see the hon. Member for Eastbourne (Caroline Ansell) is in her place—there have been concerns for a long time about whether the hospital may or may not be coming. It was recently reported by some staff that they had been told—allegedly—that a new hospital was even a bare-faced lie.

Caroline Ansell: I thank the hon. Lady for advising me ahead of the debate that she might mention the hospital in my constituency. I am not sure of her particular interest in Eastbourne, although it was named by Time Out as its place to visit in 2023. For the benefit of those in my constituency who may be following this debate, am I pleased to share that, in relation to the workforce—the matter before us today—there has been a 25% increase in full-time staff over the past 10 years. That is a 10-year increase in nurses and midwives, a 10-year increase in doctors and dentists, and a 10-year increase in allied health professionals. They also report £20 million—[Interruption.]

Rosie Winterton: Order. It is important to have fairly short interventions.

Caroline Ansell: Thank you, Madam Deputy Speaker. Is the hon. Lady therefore pleased and relieved to hear that, despite staff concerns that there would not be a new hospital, there has been a run of incredibly positive meetings and we are assured that, in the words of the chief executive, “once-in-a-generation” investment is coming?

Daisy Cooper: The hon. Lady asks about my particular interest, and she will be aware that as the Liberal Democrat spokesperson for health and social care I have asked the Government on 10 occasions about releasing funds for my local trust, and other hospital trusts across the UK, for the new hospital programme that the Conservatives promised in 2019.
Other hospital trusts are deeply concerned about the lack of progress on the new hospital programme. In Sutton, for example, St Helier Hospital was built before world war two. My own trust, West Hertfordshire Teaching Hospitals NHS Trust, which covers St Albans, Watford and Hemel Hempstead, has buildings that are life-expired. I have been there a number of times and seen the  extraordinary work by professionals in my local hospital trust. We had the first virtual ward during the pandemic, and we have two robotics suites. We also have a lift that breaks down right next to the ward that treats children who are ill. When that lift breaks down, ambulances have to be stationed outside one side of the hospital so that they can drive around to the other side. This is completely unacceptable.
Will the Minister confirm that all of those hospitals right across the UK—wherever they may be—will get the funding they were promised under the new hospital programme and that there will not be delays and penny-pinching? A Conservative Member no longer in his place asked where we would train all of the planned thousands more doctors and nurses. If there is any penny-pinching on the size of our new hospitals, they certainly will not get trained in our area.
Our NHS and social care need people, tech, beds and buildings. There is no silver bullet to solving all of the issues in our NHS and social care, but getting some proper workforce planning in place would be the closest thing to that. That is why my Liberal Democrat colleagues and I are happy to support the motion.

Richard Burgon: Just two years ago, in the middle of the greatest public health crisis in decades, millions of people came out to clap for the nurses, doctors and other NHS workers who were putting their lives on the line to save the lives of others. As people will remember, Conservative Members were only too happy to be seen joining in the applause. How times have changed.
We now have Tory Ministers wheeled out on the media to attack those same NHS workers with sick claims that their planned action for fair pay is aiding Putin’s abhorrent war on Ukraine. Those disgraceful remarks appear to be the opening salvo in a Tory propaganda war that seeks to blame NHS workers for the deep crisis in our health service. The Tories will attack nurses, as they do every other worker forced to defend their pay and conditions. But nurses did not create the NHS staffing crisis. Nurses did not create record NHS waiting lists. Nurses did not underfund our NHS. Nurses did not hand tens of billions of pounds that should have gone to the NHS over to the private sector, including in corrupt contracts. Whoever the Tories try to blame, the simple truth is this: it is 12 years of Conservative party rule that has created the crisis in our NHS.
At its core is a crisis in the NHS workforce, with workforce shortages at an unprecedented level across the NHS. The statistics are eye-watering, with 133,000 NHS vacancies in England alone and a record high of 47,000 nursing vacancies. This Tory-created staffing crisis is why patients are struggling to get a GP appointment, why heart attack patients face ambulance waiting times of more than an hour and why many are not getting the life-changing operations they urgently need.
Today we will vote on an important policy to scrap the non-dom tax status that is exploited by the super-rich to avoid £3.2 billion in taxes every year. Scrapping that, as Labour advocates, could fund a long-term plan to train enough NHS staff. For example, it could double the number of medical training places and deliver 10,000 more nursing placements.
The Tories should back that plan to put the NHS before non-doms and invest in our NHS instead of lining the pockets of the super-rich. It is a plan that would help bring about a long-term solution to this crisis. For the next two years that they are in government—that is all it will be—they should take the action needed to address the workforce crisis in the immediate term, and we cannot solve that unless we resolve the NHS pay crisis.
A third of public sector workers are actively considering leaving their jobs, and pay is a key factor in that. Key workers in our NHS still earn thousands of pounds a year less in real terms than in 2010. For example, nurses’ real pay is down by £5,200 compared with 2010, while hospital porters’ real pay is down by £2,500. Now the Government expect it to fall even further.
Staff, however much they love their jobs, simply cannot afford to stay in them. Their pay is not covering their essentials. Hospitals are even having to open up food banks for staff. That falling pay is why, over the coming weeks, nursing staff and—it was announced today—ambulance staff will be taking industrial action. Nursing staff do not want to take action, but they feel they have been left with no choice because Government Ministers will not even meet them to discuss pay.
Nurses hope that the Government will listen and open up the pay talks so that they do not have to go out on strike, but if they do strike, they will have public support and I will go and support them. It is not too late for the Government to avoid strikes. They have chosen strikes over negotiations, but they can stop this at any point. The Government need to open up the talks and they need to pay NHS workers properly. They need to give NHS workers the pay rise they deserve.

Karin Smyth: In 1948, at the dawn of the NHS, we were around 50,000 nurses short. By the 1960s, 40% of junior doctors were from India, Bangladesh, Pakistan and Sri Lanka. Thousands came from the Caribbean. It is estimated that by the 1970s, 12% of British nurses were Irish nationals, my own family among them. My Aunt Margaret Carter came to Stockport and my cousin Maureen McNulty came to Leeds. Britain welcomed them; they were not invaders. We trained them, we gave them accommodation, we offered them prospects. In the three decades I have worked in the NHS, the hundreds of nurses I have worked with remember their first job. They remember being greeted and welcomed. They remember their new belts. They remember it with great pride. We welcomed them nationally and, crucially, we welcomed them locally. We supported them with accommodation, transport and decent prospects.
In January 2019, the then Secretary of State, the right hon. Member for West Suffolk (Matt Hancock), made a statement about the long-term plan and the recommendations. Like the Secretary of State today, he talked about the largest increase in health spending. What he failed to admit, as did the Secretary of State today, was that we had witnessed a decade of the lowest growth the NHS had ever had. In particular, it badly hit public health, capital spending—why we have a £10 billion backlog on maintenance—and workforce education and training. Even if we skirt over the suppression of Exercise  Cygnus and pandemic planning, we entered the pandemic unprepared. That is why we had rushed, ad hoc, WhatsApp-panicked procurement processes—about which we will hear much more later today. That is why 2020 was so bad.
Members do not have to take my word for it. In June 2019, following that earlier statement, Baroness Harding and Sir David Behan, chair of Health Education England, gave evidence to the Health and Social Care Committee. I recommend that hon. Members read it. I totally agreed with Baroness Harding that the way we solve the workforce crisis is all about staff retention. It is all about people feeling that their careers were not being developed and that they did not have an opportunity to get on. At the time, retention rates were higher in any other profession. It was also noted that if we had kept at 2012 retention levels, we would have had 16,000 more nurses in 2019 than we had at the time. That is the problem.
There are solutions and we have heard some of them today, but they are a mix of the national and the local. At national level, we need to welcome people. We will always need overseas recruitment, but upwards of 80% of NHS staff are homegrown. We need to incentivise retention—it is cheaper, it is quicker, it is the smart thing to do. The reasons for loss of staff are well known. The Government need to revisit the Augar review. They need to notice what has happened with the loss of bursaries. We need to involve further and higher education in that retention work.
We also need to look at regional solutions. The Lansley Act, the Health and Social Care Act 2012, destroyed the regional architecture but there is still a role, still some semblance of a network, possibly grouping ICSs—we talked about that today—where NHS England could have a role without the performance stick. The emergency planning architecture, which was ignored at the beginning of the pandemic but still exists in some places and did rise to the challenge, linking local authorities and public health, could offer a skeleton of a service to co-operative supportive networks above trust and ICS level. But eventually everything is local. Just as we welcome people nationally and have national support structures to retain staff, we absolutely have to do things locally. We need to look at housing, transport, progression and, as has been said, pay and retention.
I am not particularly interested in the large figures that have been bandied around today, including the millions of people on waiting lists and the 165,000 social care vacancies; I want to know what is happening in Bristol. I want to know what is happening to GP waiting times in Whitchurch, Bedminster and Bishopsworth. I want to know the vacancy rates at the Bristol Royal Infirmary and Southmead Hospital. When I asked the Secretary of State about the vacancy rate in North East Cambridgeshire, obviously, he could not answer, because none of us in this House can answer that question. As MPs, we should know the scale of the problem in our constituencies and, frankly, we do not. We need to know and to communicate to local people what the problem is. We need to help with the local situation and priorities, and we have to build our way out of it.
There are no easy solutions, but there is a path. Sadly, the Government have not even started on that path. If we are to keep spending ever more of our country’s wealth on the NHS and care system—as we will, although  it would help if we had grown the economy more in the last 10 years—local people must have a say in that. They have to understand the trade-offs and, crucially, be able to hold someone to account locally for the parlous state of our waiting lists.

Rebecca Long-Bailey: The national health service is facing one of the worst workforce crises in its history. The decentralisation and deliberate marketisation of large parts of the health service, the driving down of staff pay, 12 years of austerity and so-called efficiency savings have brought frontline services to the brink of collapse.
A report by the Health Foundation revealed that the UK has spent around 20% less per person on health each year than similar European countries over the past decade. As a result of sustained real-terms pay cuts, some hospitals have food banks for staff, some are handing out welfare packages, and there are even reports of NHS staff sleeping in their cars as they cannot afford the fuel to and from work. It is no surprise that there are more than 133,000 vacancies across the NHS.
However, instead of helping to address the pressures faced by an overworked, underpaid and demoralised NHS workforce, the Government appear to be deliberately picking a fight with the trade unions representing those key workers by fiercely resisting entirely reasonable pay claims. There is genuine desperation out there among those workers and other key workers like them who are experiencing the definition of in-work poverty. They are not able to afford the basics of food, clothing, housing and privatised utility bill payments. It is therefore no surprise that they are left with no option but to publicly voice their desperation over low pay, unmanageable workloads and patient safety.
GMB, Unison and Unite have confirmed this week that there will be national walk-outs across the ambulance service. Nurses will strike this month for the first time in their 106-year history; they simply cannot take any more. The Royal College of Nursing’s last shift survey report found that eight in 10 shifts were unsafe, and 83% of nursing staff surveyed said that staffing levels on their last shift were not sufficient to meet all patients’ needs safely and effectively. For context, an experienced nurse’s salary has fallen 20% in real terms since 2010.
As we heard, midwives are balloting for strike action. A recent survey carried out by the Royal College of Midwives shows that more than half of staff are considering leaving the profession, citing inadequate staffing levels and concern for the quality and safety of care that they can deliver. It also estimates that the UK is short of more than 3,500 midwives.
The NHS workforce was rightly lionised by the British public for their selfless devotion and service during the pandemic, yet the abject response of the Government is to unleash yet more austerity on public services that are already cut to the bone, and to further hold down the wages of hard-pressed workers. We had reference to the autumn statement today but, staggeringly, although those workers continue to suffer, hidden in the depths of that statement was not an admittance of culpability for the current economic crisis or a plan to reverse NHS decline, but a massive tax cut on bank profits. The bank  surcharge was cut from 8% to just 3%. That comes on top of the removal of the cap on bankers’ bonuses a few months ago and the abject refusal to abolish non-dom tax status. As my hon. Friend the Member for Ilford North (Wes Streeting) said at the start of the debate, the Government made choices—and the choice they made was to prioritise the interests of a select few over the interests of the NHS, patient safety and the welfare of workers in the health service.
Today the Government have the opportunity to recognise their gross misjudgment and make the right choice. They have the opportunity to increase resources across the NHS and set out an urgent workforce plan with measures to increase retention and support staff. They have the opportunity to introduce an immediate restorative pay rise for NHS staff that reflects the value that society places on their vital work. They must also award recruitment and retention premiums to new entrants and existing staff and provide financial support for those who are studying to become NHS professionals.
NHS staff are ringing the alarm and saying that funding, pay and patient safety are inextricably linked. They are the true heroes. They do not ask for thanks; they do what they do day in, day out without fanfare because they truly care. It is time the Government showed them the respect they deserve.

Holly Lynch: It is a pleasure to follow my hon. Friend the Member for Salford and Eccles (Rebecca Long Bailey), who made an incredibly powerful speech.
I do not think I am being dramatic when I say that a genuine sense of fear has set in across the country about being in a position of needing to use the NHS. Almost every family now have a story about how they or, even worse, a loved one have needed to access care and have had a very difficult experience. People’s experiences range from waiting at A&E to waiting for an ambulance, from being unable to get a dentist appointment when they were in pain and urgently needed one to facing a wait years long to see a specialist. One member of my team called up on 25 November and was told, “You’re in luck: there’s been a cancellation at the GP’s, so they’ll book you an appointment—but it’s for a telephone consultation on 20 December.” The chronic pressures in staffing across the board are affecting healthcare in every part of the country.

Margaret Greenwood: This afternoon we have heard some horrendous stories about people waiting for ambulances: hideous delays of 16 hours or more for people in pain and sometimes truly tragic circumstances. Does my hon. Friend agree that that shows the abject failure of this Government to provide a health service that we can all be proud of?

Holly Lynch: My hon. Friend is absolutely right. Not only is there a massive impact on patient safety and care, with detrimental outcomes for patients, but there is a loss of service to others: while paramedics and ambulances wait outside A&E, there is an impact on care for all the other people who need that provision. My hon. Friend makes a really powerful point.
I want to focus on some key areas of the NHS workforce, starting with midwifery. The chief executive of the Royal College of Midwives, Gill Walton, has told  the Health and Social Care Committee that England is more than 2,000 midwives short of the numbers it needs, and the situation is getting worse. The RCM’s analysis shows that midwife numbers fell by a further 331 in the year to November 2022. We need a plan because, as other hon. Members have said, the staffing shortages are driving further staffing shortages. More than half of all midwives surveyed by the RCM said that they were considering leaving their job, with 57% saying that they would leave the NHS in the next year.
In November last year, I joined a March with Midwives rally in Halifax, where midwives held up signs that they had made themselves and that said things like, “I’m a physically and mentally exhausted midwife”, and, “I can’t keep saying sorry for no beds, no midwives, no support and no time”. What really brought home how it is not just about the impact of short staffing on patients and patient safety was the signs that midwives’ children had made themselves. One sign said, “My Mum falls asleep on the driveway after work”. It was made by a girl who told me that she had come out of the house one morning ready for school, only to find that her mum had driven home after a nightshift, pulled on to the driveway and fallen asleep in the car because she was so exhausted. A younger child had made a sign that simply said, “Mummy being late from work equals me being a lonely kid”.
Case studies conducted by the Royal College of Midwives highlighted not just the strain on the service, but the strain in the workforce and their families. A midwife called Julia said:
“We’re reducing the time we give to women, having to close facilities, reduce antenatal education, postnatal visits cut to a minimum. Stretched physically is one thing, you can rest your body eventually when home, but the mind, the mind does not have an easy off switch. The constant unrealistic expectations on maternity staff is damaging their mental health, it’s impacting on the wider service and it’s putting women, babies and families hopes and dreams in danger.”
This is why a Labour Government with a commitment to train 10,000 additional nurses and midwives every year cannot come fast enough.

Karin Smyth: My hon. Friend is making some excellent points, particularly about the impact of those exhaustion levels on families. In my speech I spoke about the recruitment of families who looked forward to their jobs and were proud of working in the NHS. That is important to bringing future generations into the health service, and giving encouragement to young people in schools. It is still a fantastic career, but does my hon. Friend agree that helping young people not to be deterred by that negative publicity and helping them through training routes is a crucial way of solving the current workforce problems?

Holly Lynch: We have all told stories about the NHS heroes in our constituencies today, but my hon. Friend is right about the need to transform that into an attractive skills plan. Some of the midwives and their children whom I met were extremely proud to be in NHS families. Every member of those families is affected by that shared sense of pride, but also by that shared sense of exhaustion, and there are problems for the whole family when there are problems for the NHS worker. My hon. Friend has made a powerful point.

Emma Hardy: As I pointed out in my speech when I was talking about radiotherapy, the reason people are leaving the profession is to do with the work-life balance. It is not just a question of the number of people who are leaving midwifery, but a question of the number of people in midwifery who are reducing their hours to try to achieve that balance. Does my hon. Friend agree that something is seriously amiss when people have not fallen out of love with the job, but are simply finding that they cannot do the job while also maintaining the home life that they need?

Holly Lynch: Once again, my hon. Friend is absolutely right, as I know when I meet those children of NHS staff who hold up signs saying, “When my mummy is late home it means that I am a lonely kid”. As other Members have pointed out, when NHS workers are exhausted at the end of a shift but find that the cavalry is not arriving and there is no one to take over, they cannot walk out of their jobs as other people might be able to. They have to stay and deliver patient safety, rather than leaving those patients at risk. Questions about the life-work balance and childcare—who will feed the kids when they get home?—are not easy questions for workers in that position to answer.
We have to transform the experiences of mothers and families using maternity services. Like almost every other parent who has had to use those services in recent years, I can say that it is a massive worry. You are told, “Once your waters have broken and your contractions are this regular, come to the hospital”, but even after that point I kept being asked not to come to the hospital, because there was only one bed left and it might be needed for someone else. That is the last thing you want to hear when you are in labour. Worrying about staffing and bed shortages compounds what is already one of the most stressful experiences that women—indeed, parents—can go through.
Let me now say something about paramedics, and all those working on the frontline of our ambulance services. I have worked closely with paramedics, in particular with the GMB’s union representative, Sarah Kelly, on the Protect the Protectors campaign, and I have spent a day out with paramedics, seeing just how relentless their days are. Analysis carried out by the GMB found that there were 7.9 million calls for an ambulance in 2010-11, but by 2021-22 that had risen to 14 million, a pretty staggering increase of 77%. The monthly handover delays report from the Association of Ambulance Chief Executives reveals that the performance of ambulance services fell to its lowest ever level in October. The report shows that, across the month, 169,000 hours of ambulance crew time were lost due to delays. That meant that paramedics could not answer over 135,000 calls for help. That number represented 23% of ambulance services’ total potential capacity to respond to 999 calls. All three of these metrics are the worst in the NHS’s history.
Staff have balloted for industrial action, and we can see how they do not feel listened to and that they are carrying so much responsibility. My hon. Friend the Member for Ilford North (Wes Streeting) has already made this point powerfully from the Dispatch Box. None of us here in the Chamber today has to face the reality multiple times a day of knowing that, no matter how hard we work, there could be fatal consequences for the vulnerable people we are looking after because  the system in which we work is fundamentally failing. We do not carry that burden; we ask the paramedics, and all NHS staff, to carry it.
We know that, in addition to this, too many workers—after making such an exhausting contribution to the NHS—are facing financial hardship for their efforts. Like in midwifery and other areas of the NHS, research indicates that one in 1,000 ambulance workers have left since 2018 to seek a better work-life balance or better pay, or to take early retirement. It is not that workers are asking for more pay for the sake of it; it is because inflation is at 11%, energy bills have gone through the roof and the cost of fuel to enable them to get to  work has shot up. The National Institute of Economic and Social Research has predicted that around 30,000 households could see their monthly mortgage repayments become greater than their monthly income in the months ahead. If the Government got a grip of these factors, they would not have so many workers being forced to ask for more pay just to make ends meet. I ask the Government to please speak to workers, to work with their trade unions and to work through their concerns, which are very real.
Turning to NHS dentistry, I presented a petition to the Government on 1 November on access to NHS dental care, signed by 549 people online as well as a number of signatures in hard copy—some are still coming into my office. Like all MPs, I have had so much casework in recent months where local people simply cannot see an NHS dentist. The British Dental Association says that more than 43 million dental appointments were lost between April 2020 and April 2022, including more than 13 million appointments for children.
Dentistry is now the No. 1 issue raised with HealthWatch, with almost 80% of the people who contact the organisation saying that they find it difficult to access dental care. The General Dental Council says that almost a quarter of the population—24%—report having experienced dental pain in the last 12 months. More locally, HealthWatch in Calderdale contacted every dental practice across Calderdale last year to establish whether they were willing to accept new NHS patients, whether they would register a child and whether they were offering routine appointments. Every dental practice told HealthWatch that it could not currently register a new NHS patient of any age. It is the same story.
Data from the British Dental Association reveals that 3,000 dentists in England have stopped providing NHS services since the start of the pandemic. For every dentist leaving the NHS entirely, 10 are reducing their NHS commitment by 25% on average. A BDA survey from May 2022 shows that 75% of dentists plan to reduce the amount of NHS work they do next year, with almost half planning to change career, seek early retirement or enter fully private practice. As in other areas of the NHS, the combination of pressures and remuneration is driving what remains of a depleted workforce away. It is a self-defeating cycle that the Government have to step in to break.
Other Members have made points today about the potential of community pharmacies. Having worked in a pharmacy when I was in the sixth form doing my A-levels, it became clear to me that this was often the longest standing and most trusted relationship that  members of the community had with a healthcare professional. The pharmacy was the shopfront that was always open during the pandemic, where people could go and meet somebody who knew them and knew their circumstances. That really is the value of community pharmacies. We know they have the capacity to do so much more, and hon. Members on both sides of the House have spoken about unlocking that potential and relieving some of the pressure on A&E departments and GP surgeries by empowering community pharmacies to deliver the work they are best placed to deliver because of their deep roots in our communities.
Labour has a plan for the NHS. It is costed, comprehensive and will save the NHS. In today’s debate, the Government have not had the humility even to acknowledge that there is a problem in the NHS, never mind having a plan of action. That is why a Labour Government cannot come soon enough.

Margaret Greenwood: It is clear that we have a crisis in NHS staffing. For the very first time in its 106-year history, members of the Royal College of Nursing have voted for strike action in their fight for fair pay and safe staffing. I express my solidarity with them. They do not do this lightly. Consecutive Conservative Governments have brought them to this situation.
Staff shortages are putting immense pressure on the NHS. There were more than 133,000 vacancies in the NHS in England in September 2022, up from around 103,000 the year before. There were more than 47,000 registered nursing vacancies in September, about 8,500 more than in March, and there were more than 9,000 medical staff vacancies in September, over 1,000 more than in March.
We all know things were bad before the pandemic, but an already extremely serious situation has got worse. This staffing crisis is a direct result of the failure of Conservative Governments to plan and deliver the workforce we need, and it is leading to very high levels of stress for staff and extraordinarily long waiting lists for patients.
Two weeks ago, I led a Westminster Hall debate on NHS staffing. Numerous organisations provided briefings in advance of that debate, and I will share some of their concerns about staff shortages, the pressures on the NHS and the impact they are having on workers and patients. Their observations reflect the depth of the crisis in the NHS, along with the complexity of medicine and the immense level of expertise in this country. The Government really should listen to them.
Research by the British Medical Association points to a lack of doctors in comparison with other nations. The average number of doctors per 1,000 people in the OECD’s EU nations is 3.7, but England has just 2.9. Meanwhile, Germany has 4.3.
Parkinson’s UK has said:
“People with Parkinson’s are facing huge waiting times for diagnosis, mental health support, check-ups and medication reviews. This is due to critical shortages of NHS staff across England who are available to see people with Parkinson’s. Problems with finding healthcare professionals who understand the condition and accessing the right specialist services have been exacerbated by the pandemic. Waiting times for a consultant after diagnosis are up to two years in some areas.”
The Royal College of Midwives has expressed serious concerns that the NHS in England has 800 fewer midwives than it did at the time of the 2019 general election and that
“midwife numbers are falling in every region of England.”
According to the latest census by the Royal College of Physicians
“52%—more than half—of advertised consultant physician posts were unfilled in 2021. That is the highest rate of unfilled posts since records began, and of the 52%, 74% went unfilled due to a lack of any applicants at all.”
The Royal College of Speech and Language Therapists has said:
“Speech and language therapy services across the entire age range are facing unprecedented demand and there are simply not enough speech and language therapists currently to meet the level of demand.”
Last year’s report by the British Society for Rheumatology found that
“chronic workforce shortages mean departments lack sufficient staff to provide a safe level of care.”
This means
“patients are experiencing progressively worse health, leading to unnecessary disability and pain.”
Cancer Research UK has pointed out that
“critical staff shortages impact all aspects of cancer care”—
I would have thought the Secretary of State would like to listen to what Cancer Research UK has to say. It highlights:
“In 2020-21, £7.1 billion was spent on agency and bank staff to cover gaps in the NHS workforce, an increase of almost £1 billion from an already enormous £6.2 billion spent the year before. This is money that could be spent on training and recruiting full-time equivalent NHS staff, but instead is”—
being used—
“in an attempt to mitigate chronic NHS staff shortages.”
Unison has said it is
“very concerned that NHS services are in a dire state due to there being insufficient staff numbers available to deliver safe patient care.”
It points out:
“While the government has belatedly accepted the need for an independent assessment of the numbers of health professionals needed in future, they repeatedly refused to write such plans into the Health and Care Act 2022, despite a broad coalition of more than 100 healthcare organisations calling for this.”
The TUC is calling on the Government to put in place
“an urgent Retention Package, with a decent pay rise at its heart.”
The 2022 pay award is well below current inflation levels, so it amounts to a real-terms pay cut. The TUC went on to say:
“The 2022 pay uplift needs to be set at a level which will retain existing staff within the NHS”,
is attractive to new recruits,
“and recognises and rewards the skills…of health workers.”
In recent weeks, we have seen announcements of industrial action from other organisations representing NHS workers, including Unite the union, Unison and the GMB. In addition, the Chartered Society of Physiotherapy is balloting members and the British Medical Association will ballot next year. As with the Royal College of Nursing, this is not being done lightly. NHS workers care deeply about patients and the service as a whole, but they can also see that the NHS is at  breaking point. It is notable that, in a recent poll of 6,000 adults carried out on behalf of Unite, 73% of respondents supported NHS and care workers receiving pay rises that keep up with the cost of living.
The Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on and planning and delivering a well-resourced, well-staffed NHS, the Conservatives have focused their energy on not one but two major reorganisations of the NHS, designed to open it up to privatisation. This ideological agenda is causing immense suffering to patients and great stress for staff.
The Health and Care Act 2022 provided for the revoking of the national tariff and its replacement with a new NHS payment scheme. The national tariff is a set of rules, prices and guidance that covers the payments made by commissioners to secondary healthcare providers for the provision of NHS services. Engagement on the NHS payment scheme is ongoing, with a statutory consultation due to begin this month. Given the requirement in the Act for NHS England to consult each relevant provider, including private providers, before publishing the scheme, I am very concerned that this may well be a mechanism through which private health companies will have the opportunity to undercut the NHS. If that happens, one inevitable outcome would be an erosion of the scope of “Agenda for Change”, as healthcare that should be provided by the NHS is increasingly delivered by the private sector. I ask the Minister to give us an assurance that that will not be used in that way.
As I have said, the Conservative Governments’ failure to address chronic staffing shortages in the NHS is putting those working in the service under immense pressure and, in some instances, it is putting patients at risk. Since 2010, instead of focusing on planning and delivering a well-resourced, well-staffed NHS, they have focused on a privatisation. In the second reorganisation, they held a consultation, allegedly, when NHS staff were working incredibly hard during the pandemic. It was very unfair to carry out a consultation while the people to be affected most by it were dealing with the worst public health crisis we have seen.
The staffing crisis has been created by the Conservatives on their watch. The comprehensive workforce plan announced in the autumn statement is due to be published next year. It is long overdue and it will need to be backed up by sufficient resources. In the meantime, the Government bear a responsibility in relation to how the NHS fares this winter. They have the opportunity to avert industrial action and should do all in their power to do so. They must support those who work in the service and make sure that NHS workers receive a fair pay rise.

Rosie Winterton: I call the shadow Minister.

James Murray: There can be no doubt that the NHS is in crisis. We have heard shocking stories today from hon. Members about what their constituents are having to endure. Each and every one of these deeply distressing stories helps to confirm the devastating impact of the Conservatives’ neglect of  the NHS. Patients deserve so much better than this Government and everyone who works in the NHS deserves so much better, too, for the invaluable work they do.
We all know that from the experience we have in our constituencies, as we have heard so powerfully today. My hon. Friend the Member for West Ham (Ms Brown) spoke powerfully and in detail about the impact of vacancies in the NHS, particularly in maternity services, in her constituency and the surrounding areas. My hon. Friend the Member for Coventry North West (Taiwo Owatemi) spoke about the role of community pharmacists and the wider struggles that NHS workers face. She was speaking with particular authority, given her background in the NHS before becoming an MP. My hon. Friend the Member for Ilford South (Sam Tarry) spoke about the severe impact of vacancies and exhaustion in nursing after 12 years of the Conservatives.
My hon. Friend the Member for Kingston upon Hull West and Hessle (Emma Hardy) spoke about the impact that workforce shortages were having, even before the pandemic, on crucial radiotherapy services in her constituency and beyond. My hon. Friend the Member for Streatham (Bell Ribeiro-Addy) spoke about the scale of the crisis that we face in NHS recruitment and retention. My hon. Friend the Member for Leeds East (Richard Burgon) rightly mentioned those shameful attacks by Conservative Ministers on nurses.
My hon. Friend the Member for Bristol South (Karin Smyth) spoke with great experience, having spent three decades working in the NHS, about the growing crisis of retention over the past decade. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) spoke about the NHS crisis and set it in the context of the Government’s unfair decision in the recent autumn statement. My hon. Friend the Member for Halifax (Holly Lynch) gave a wide-ranging and powerful speech that drew attention to the genuine sense of fear among people across the country at the prospect of not being able to access vital NHS services. My hon. Friend the Member for Wirral West (Margaret Greenwood) made it clear that the staffing crisis in the NHS is the failure of 12 years of the Conservatives.
Madam Deputy Speaker, that is the truth. The Conservatives have spent 12 years running down the NHS and letting our economy fall further and further behind, but, make no mistake, this is not inevitable. After 1997, Labour not only grew the economy 1.5 times the rate that the Conservatives subsequently managed, but delivered an NHS to be proud of, and we are proud of our record.
Although the challenges now are even greater than they were in the late ‘90s, if we take office at the next election, we will, again, deliver a modern, sustainable NHS that is fit for the future that we face. We know that, to make the NHS fit for the future, it needs a prescription of reform and sustainable funding from a growing economy. For our economy to grow, we need to start getting our public services back on track, too. As my hon. Friend the shadow Health Secretary set out, one of the first steps that a new Labour Government will take to get the NHS back on track is to deliver a workforce plan that addresses the root cause of the crisis it is in.
Under our plan, we would double the number of medical school places to 15,000 a year. We would double the number of district nurses qualifying each year. We would train 5,000 new health visitors a year and we would create 10,000 more nursing and midwifery clinical placements each year, too—all part of a long-term workforce plan for our NHS.

Steve Brine: On the doubling of the number of medical school places, can the hon. Gentleman tell me what the cost of that is, especially as the shadow Chancellor is so handily sitting next to him? It would be helpful for those of us on the Select Committee to put the price tag on that one.

James Murray: All the pledges that the Opposition make are fully costed and fully funded. [Interruption.] If the hon. Gentleman waits one second, I will address that point. Today is about political choices. It is not just a political choice of whether we invest in the NHS; it is a political choice of how we pay for it. That is why we have made it clear that, to pay for our NHS workforce expansion plan, Labour would abolish the unfair, outdated non-dom tax status. Non-dom tax status is passed down through people’s fathers and it costs the public purse £3.2 billion a year, while failing to support economic growth in the UK. Under the current arrangements, a small group of high-income people who live in the UK are able to avoid paying tax on their overseas income for up to 15 years. We would abolish that 200-year-old tax loophole and introduce a modern scheme for people who are genuinely living in the UK for short periods. We believe that if a person makes Britain their home, they should pay their taxes here.

Paul Bristow: My hon. Friend the Member for Winchester (Steve Brine) asked the hon. Gentleman a very specific question about the exact cost of doubling the number of places at medical school. Is the hon. Gentleman able to confirm the exact cost of that—not the non-dom cost, but the exact cost of doubling the number of medical places?

James Murray: I thank the hon. Gentleman for his intervention. I have set out that scrapping the non-dom status would raise £3.2 billion, and that our workforce expansion plan would cost £1.6 billion, so we would be well able to afford that measure from the amount of money that we have raised from scrapping this outdated, unfair tax loophole.
Non-dom status should have no place in our modern tax system. It is unfair. When the Government are making working people pay more tax, it is simply wrong to allow wealthy people with overseas income to continue to benefit from an outdated tax break. It is also bad for UK business: the loophole prevents non-doms from being able to invest their foreign income in the UK, as bringing it here means it becomes liable for UK tax. Abolishing non-dom status would end that barrier to UK investment—and, as I have said, raise £3.2 billion, money we would use to put towards priorities including expanding the NHS workforce.
To be honest, we would have thought abolishing non-dom status, replacing it with a modern system and using the money to strengthen the NHS and economy would be a no-brainer. What is it about this Conservative Government, led by the right hon. Member for Richmond (Yorks) (Rishi Sunak), that makes them so reluctant to  close that loophole? Last week, during the rushed debates on the Government’s autumn Finance Bill, I asked Treasury Ministers to confirm whether the Prime Minister had been consulted on the option of abolishing non-dom status and whether it was ever considered as an option for last week’s Finance bill. I also asked whether, when the current Prime Minister was Chancellor, he had ever recused himself from discussions on the matter, for obvious reasons.
I put these questions to Treasury Ministers on three separate occasions last week, but they refused each time even to acknowledge the questions, never mind answer them. For a Minister to overlook a set of questions once might be an oversight, but to ignore them three times looks like something else. Perhaps the Minister will today show that they have nothing to hide by answering the questions I have raised.
In the autumn statement and last week’s Finance Bill, the Chancellor chose to leave non-dom status untouched, while picking the pockets of working people, including nurses, with stealth taxes such as freezing income tax thresholds and pushing up council tax. Today, the Secretary of State for Health only mounted a brief defence of non-dom status; I wonder whether his colleague from the Treasury will, in her closing remarks, repeat some of the defences that Treasury Ministers tried to set out last week.
Last week, Ministers tied themselves in knots trying to find a justification for the £3.2 billion tax break for non-doms. They tried to pretend that the Government's investment relief is working, when only 1% of non-doms invest their overseas income in the UK in any given year, and last week they tried to win praise for ending permanent non-dom status, while keeping quiet about the new loophole they created, which allows people to use trusts to retain non-dom benefits permanently.
The truth is that, unless the Conservatives vote with us today to abolish non-dom status once and for all, the British people will be clear that no amount of reason or common sense will get this Government to come round. The British people need a fresh start and a new Labour Government that would take those fairer choices on tax to support the stronger NHS we so desperately need.
The NHS is an achievement we share together as a country and one that we all have a personal relationship with. We all want to know that when we have medical symptoms, concerns or needs, the NHS will be there for us. We want to know it will be there as a publicly funded  service, free at the point of use, able to provide us with the high-quality help we need. That is what I wanted to know in my early 20s, when I started to notice symptoms of what would later be diagnosed as myasthenia gravis, a rare neurological condition that caused muscle weakness throughout my body.
After the best care I could have hoped for from my brilliant consultant and his team and colleagues at the National Hospital for Neurology and Neurosurgery in Queen Square, I have been symptom-free for many years now, but the memory of first feeling those symptoms and then finding my way towards the right treatment sticks with me. I would never want anyone to feel symptoms like mine and not be sure whether the NHS would be there to help.
We all know stories like that. We all need the NHS to diagnose and treat us when we are worried. We all need to be able to turn to the NHS so that we get that treatment in good time. We all connect with the NHS through our own lives and the lives of our family and friends. That is why the NHS matters so much to us all and why we are so determined to deal with the crisis the NHS is facing and to make sure it is ready for the modern challenges we face.
At the heart of our vision for the country are stronger public services and stronger economic growth. We know that getting public services back on track will support a growing economy, which will in turn support modern, sustainable public services. Before us today we have a chance to end the unfair 200-year-old tax loophole, which lets a small number of people avoid tax on overseas income, and use the money saved to fund one of the biggest workforce expansion plans in the history of the NHS. That is the choice in front of us today, and I urge all MPs to do the right thing by backing our plan.

Royal Assent

Rosie Winterton: I have to notify the House, in accordance with the Royal Assent Act 1967, that His Majesty has signified his Royal Assent to the following Acts:
Identity and Language (Northern Ireland) Act 2022
Product Security and Telecommunications Infrastructure Act 2022
Counsellors of State Act 2022
Northern Ireland (Executive Formation etc) Act 2022

NHS Workforce

Debate resumed.

Victoria Atkins: It is a genuine pleasure to close this debate on behalf of the Government. I start by placing on the record my thanks to the extraordinary staff of the national health service, on whom this country relies day in, day out. As the Chancellor told this House less than three weeks ago,
“The service we depend on more than any other is the NHS.”—[Official Report, 17 November 2022; Vol. 722, c. 849.]
Indeed, the NHS is one of the reasons why I took the decision to put myself forward for public office. The national health service diagnosed my type 1 diabetes at the age of three, and I have been genuinely moved and supported by the NHS ever since then. It is thanks to the NHS that I am standing at this Dispatch Box.
Maintaining the service relies, above all, on the foundations of a strong economy, which was exactly the purpose of the autumn statement. We acknowledge that there are specific issues that need tackling, and the Chancellor—himself a former Health Secretary—was frank in seeking to address them. Members may recall that we debated the pressures facing the economy, and the No. 1 issue facing the economy at the moment is inflation. It is precisely because inflation is at a generational high that the prices of everything our constituents buy and rely on have gone up, including, of course, food and heating. That hurts everyone, but it hurts the poorest the most. That is why, in the autumn statement, we laid out a plan to tackle inflation, to grow the economy and to protect public services.
One of the most effective measures according to the Office for Budget Responsibility was the introduction of the energy price guarantee coupled with payments for the most vulnerable in society. Again, should any colleagues need help with their constituents, they can direct their constituents to help on the Government website helpforhouseholds.campaign.gov.uk. The OBR said that our plan has helped to dull inflation by a couple of points and to protect 70,000 jobs, and that it has ensured that this recession is shallower than it would otherwise have been. There was some discussion during the debate about growth. I gently remind the House that we had the third highest rate of growth in the G7 from 2010 to 2022.
I turn now to the important subject of the NHS workforce. The hon. Member for Wirral West (Margaret Greenwood) rightly acknowledged that this extraordinary organisation has just been through the worst public health crisis we have ever seen—I think she put it extremely well. I hope that we are all able to discuss this in a measured way that does not need to fall into ideological argument when we acknowledge the impact that that extraordinary event has had on our workforce. Members from across the House referenced the exhaustion that NHS staff feel and the impact it has had on waiting lists.

Margaret Greenwood: I also pointed out that the crisis predates the pandemic. I would be grateful if the Minister acknowledged that, too.

Victoria Atkins: Forgive me. Perhaps the hon. Lady misunderstood me; I was trying to be collegiate in referencing what she had said about covid. We do know, of course, that there have been pressures on the workforce and on the NHS throughout its decades of history. Every generation has the new challenge of ensuring that the NHS meets the hopes, needs and expectations of our constituents.
In opening the debate, my right hon. Friend the Secretary of State for Health and Social Care set out our plans for the NHS and explained that we are taking specific steps on issues such as workforce shortages. We will have an independently verified plan for the number of doctors, nurses and other professionals that we will need in five, 10 and 15 years’ time, taking full account of the need for better retention and productivity improvements. That will build on what are already significant statistics. Between September 2019 and August 2022, the NHS had more than 14,000 more hospital doctors and more than 29,000 more nurses and health visitors.

Richard Burgon: The Minister spoke a few moments ago about the importance of approaching this issue in measured tones, so this is an important opportunity for her to say that her ministerial colleague was wrong to attempt in the media to associate our NHS staff with Vladimir Putin’s horrific invasion of Ukraine. I think it is really important that she rights that wrong by correcting that, please.

Victoria Atkins: I have not seen it myself but, from descriptions I have heard, I am not quite sure that is what he was trying to—[Interruption.] Members ask why I have not watched it. I was actually getting ready for a birthday party for my 10-year-old. We are allowed lives outside this place.
For those who have commented on workforce figures over the past decade, between May 2010 and August 2022, 36,000 more hospital doctors and 38,000 more nurses and health visitors were recruited. We are also asking the NHS, like all public services, to tackle productivity and inefficiency. My hon. Friend the Member for Peterborough (Paul Bristow) emphasised the importance of that and brought his experience to the debate.
To help colleagues, the initial findings by Patricia Hewitt, the former Labour Health Secretary, will be delivered to the Department within three weeks, which shows the pace of work that Ms Hewitt and others are taking on this important project. In addition, we are boosting NHS funding by £3.3 billion next year and by another £3.3 billion the year after that, helping to ensure that the NHS can take rapid action to improve urgent and emergency care and to get elective performance back to pre-pandemic levels.

Sam Tarry: Will the Minister give way?

Victoria Atkins: I will just make a little progress, if I may. Amanda Pritchard, the chief executive of the NHS, has said that this should
“provide sufficient funding for the NHS to fulfil its key priorities”
and shows that the Government are serious about their commitment to prioritise the NHS.
The hon. Member for Coventry North East (Colleen Fletcher) and my hon. Friend the Member for Peterborough emphasised the role that pharmacies can play, and I hope we can discuss ways that different services can be  delivered differently over the NHS in the coming months and years. My hon. Friend the Member for Winchester (Steve Brine), who chairs the Health and Social Care Committee, made the sound point that prevention is part of productivity.
Overall, the NHS resource budget in England is expected to increase to £165.9 billion in 2024-25, up from £123.7 billion in 2019-20. Our determination to deal with the covid backlogs has seen the NHS already hit its first milestone in terms of waits of over two years, and it will go further, eliminating waits of over 18 months by April next year, over 15 months by March 2024, and over 12 months by March 2025. My right hon. Friend the Secretary of State compared that with the figures in Labour-run Wales, and noted that a fifth of the population there is waiting for care and remarked on the curious anomaly that Wales stopped publishing its workforce vacancy rates in 2011.

Sam Tarry: Will the Minister give way?

Victoria Atkins: I will, but then I must make progress.

Sam Tarry: The Minister talks about waiting lists dropping. I would like to hear an explanation as to how, in one 24-hour period last week, in the whole of the UK, there was one paediatric intensive care unit bed. What is her explanation for that?

Victoria Atkins: The hon. Gentleman raises a serious point. I do not have the answer to hand, but I will ensure that the relevant Health Minister writes to him, because I understand why he raises it.
There has been a great deal of discussion about nurses’ pay, and we are extremely regretful and very much hoping that accommodations and agreements can be found. To put into context recent pay rises, more than 1 million staff including nurses have benefited from a pay rise of at least £1,400 backdated to April this year. That is on top of the 3% pay rise they received last year. My hon. Friend the Member for Winchester asked an interesting question: does Labour support or oppose the independent pay review bodies, which set the recommendations that have been accepted?

Karin Smyth: Will the Minister give way?

Victoria Atkins: I will not, because I have to finish.
Turning to non-doms, I must congratulate the shadow Minister, the hon. Member for Ealing North (James Murray), on his florid use of language in relation to my advocacy efforts in the Finance Bill debates. I hope that I am able to answer his question in a moment. The motion deals with non-dom taxpayers. As I have said repeatedly—and I hope at some point it will get through—non-dom residents who live in the UK have to pay UK taxes on their UK income and gains, just like everybody else. That raised £7.9 billion last year, and non-doms have invested £6 billion.
The area over which there is disagreement is the rules relating to foreign income, and the Opposition ask whether this is the answer. I have listened with great interest to how the sum they have put in their motion is apparently going to answer all sorts of economic difficulties, particularly during consideration of the Finance Bill, and I am not sure it will quite add up. Interestingly, it  was a Conservative Government who reformed non-dom laws to end the ability to claim this status permanently, and I note that the non-dom status survived during 13 years of Labour government. In any event, the Chancellor said very frankly in evidence to the Treasury Committee last week that he has asked officials to look at it.
We have the workforce strategy, which will be delivered. NHS England has done considerable work, and we hope that it will report as soon as possible. It has been a real pleasure for me to be able to praise the NHS and thank its extraordinary staff. What the NHS needs is a Government making the right decisions for the economy, so that we can actually afford a world-class health service. That is what this Government are determined to deliver.
Question put.

The House divided: Ayes 226, Noes 0.
Question accordingly agreed to.
Resolved,
That this House recognises that the National Health Service is facing the worst workforce crisis in its history with a shortage of 9,000 hospital doctors and 50,000 nurses; condemns the Government’s failure to train enough NHS staff to tackle this crisis; regrets that, as a result, patients are finding it impossible to get a GP appointment, ambulance or operation when they need one; calls on the Government to end the 200-year-old non-domiciled tax status regime which currently costs taxpayers £3.2 billion a year; and further calls on the Government to use part of the funds raised to invest in the NHS workforce by doubling the number of medical training places, delivering 10,000 more nursing and midwifery clinical placements, training twice the number of district nurses per year and delivering 5,000 more health visitors to guarantee that the NHS has the staff to ensure every patient can access the care they need.

Toby Perkins: On a point of order, Madam Deputy Speaker. Once again we have had an Opposition day debate where the Government have refused to vote. We had an incredibly important motion in front of the House, on a matter of significant importance and interest to my constituents. In the first seven years I was in Parliament, we always had votes on Opposition days, and this is one of the ways that the Government are undermining the House of Commons and refusing to listen. The motion was passed by the House and contains a specific request, which the Government will go on and ignore, as they have done before. Has there been any discussion by Mr Speaker about reasserting the position of this House? It was never the case in the past that the Government ignored Opposition days; in fact, the Blair Government changed the policy on Gurkhas as a result of an Opposition day debate that they lost. Has there been any discussion about reasserting the voice of Parliament, so that when the House passes a motion, the Government listen to it?

Rosie Winterton: I thank the hon. Gentleman for his point of order. I am sure he is well aware that a motion such as the one we have just passed would not be binding. As he says, it was the case that Governments might participate a little more in the votes than they have recently, and it was the case some time ago that the Government agreed to give a response to motions that have been passed. It is up to individual Members and the Government to decide whether they wish to participate in votes; it is not the job of the Speaker to compel them, which I am sure the hon. Gentleman appreciates as well. I am not aware of any current discussions with the current Leader of the House, but perhaps the hon. Gentleman could raise this issue in business questions if he wished, and I am sure that those on the Treasury Bench will have heard his comment.

Government PPE Contracts

Rosie Winterton: Before we begin this debate, I would like to remind Members that the motion gives general reasons why the House might agree to the Humble Address. The normal rule that reflections must not be cast upon Members of either House of Parliament, except on a substantive motion, remains in force. I am sure right hon. and hon. Members will ensure that that rule is stuck to in their speeches. I call the Deputy Leader of the Opposition.

Angela Rayner: I beg to move,
That this House –
(a) notes that the Department for Health and Social Care purchased more than £12 billion of Personal Protective Equipment (PPE) in 2020-21;
(b) regrets that the Government has now written £8.7 billion off the value of this £12 billion, including £4 billion that was spent on PPE which did not meet NHS standards and was unusable;
(c) is extremely concerned that the Government’s high priority lane for procurement during the pandemic appears to have resulted in contracts being awarded without due diligence and wasted taxpayer money;
(d) considers there should be examination of the process by which contracts were awarded through the high priority lane; and
(e) accordingly resolves that an Humble Address be presented to His Majesty, that he will be graciously pleased to give direction that all papers, advice and correspondence involving Ministers and Special Advisers, including submissions and electronic communications, relating to the Government contracts for garments for biological or chemical protection, awarded to PPE Medpro  by the Department for Health and Social Care, references CF-0029900D0O000000rwimUAA1 and 547578, be provided to the Committee of Public Accounts.
The motion before the House is simple: this is a plea for answers, clarity and the truth. The choice that the House makes today is also simple. Our demand is clear: end the cover-up and begin the clean-up. We already know that the so-called VIP lane for personal protective equipment enabled the shameful waste of taxpayers’ money and inexcusable profiteering by unfit and unqualified providers. We know the Government have already written off £10 billion of public funds spent on personal protective equipment that was either unusable, overpriced or undelivered. Ministers have admitted that they are still paying £770,000 a day of taxpayers’ cash to store gloves, goggles and gowns. That is enough to pay for 75,000 spaces in after-school clubs, or 19,000 places in full-time nursery care. Every day, £106,000 of that money is sent to China to pay for storage costs alone.
We already know that £4 billion-worth of unusable PPE was burned to generate power after 70 million PPE items were sold off for just £400,000. What we do not yet know is what was said in correspondence between the key participants on the Government Benches and their unqualified cronies on the make and on the take. We do not even know exactly where our money ended up, but we do know that, if Ministers get their way, the system could be used again and the scandal repeated, enriching fraudsters at the expense of the taxpayer and creating a new mountain of waste.

Toby Perkins: My right hon. Friend is absolutely right that this is a scandalous waste of public money. Equally important is that our care  sector and health sector were desperate for PPE during the pandemic. Specialised Canvas in my constituency changed all its manufacturing to be able to make PPE and got a large number of contracts from individual trusts, but it was completely unable to get any contracts out of the Department of Health and Social Care. So alongside the public money wastage, we also had nurses and carers unable to access PPE at the height of the pandemic when they desperately needed it.

Angela Rayner: My hon. Friend is absolutely right. He made two points, which I will come to in greater detail in my speech, but one was the lack of PPE for those on the frontline, as well as the total disrespect in the way that contracts were handed out through the VIP lane, at the expense of businesses up and down the UK that had experience and could have helped during the pandemic, but which were not party to WhatsApps or whatever else got them to Ministers and access to the VIP lane.
Take the mystery of a PPE company with links to a Tory politician. While it is for the authorities to decide whether any law is broken, and I will not comment on the ongoing investigations, we do know that PPE Medpro was referred to the VIP lane by a sitting member of the Cabinet after lobbying from another Tory politician five days before it was even legally registered as a company. The House may recall that that particular company was subsequently awarded two contracts worth £203 million to supply PPE, with £81 million to supply 210 million face masks awarded in May 2020 and a £122 million contract to supply 25 million surgical gowns awarded in June 2020. The face masks were bought by the Government from PPE Medpro for more than twice the price of identical items from other suppliers, and the surgical gowns were rejected for use in the NHS after a technical inspection. All of them were never even used. It points to a total failure of due diligence and the rotten stench of cronyism.

Helen Hayes: During the early months of the pandemic, I was contacted by PPE suppliers known to the NHS—they were long-term suppliers—who told me that their offers of help were being rejected. One wrote to me and said that before April 2020
“there was a degree of total incompetence about government handling of PPE purchases. However, by the way they scrutinised our own offers, thereafter, we believe they knew, at least specification-wise, exactly what they were doing and that senior managers were taking steps to use ‘preferred suppliers’, even though they were aware these suppliers had neither the track record nor the level of competence to produce compliant goods”.
What does my right hon. Friend think about that?

Angela Rayner: I think it absolutely stinks, and my hon. Friend is absolutely right, in that the public can see through it, as can those businesses, who are pretty angry. They knew that Britain faced a situation with a global pandemic that it had not faced before and they wanted to do the right thing by doing their bit. The frustration—my hon. Friend is right to quote her business—is that there is no question that the specifications should have been known. Therefore, why was all this PPE bought knowing full well it could not be used?

Andy McDonald: Does my right hon. Friend agree that the mood in her constituency, as in mine, apposite these dealings is one of faith being  completely shaken in the good governance and process of this nation? At the very least, people are saying that moneys obtained and goods not properly utilised have to be returned and, if circumstances so dictate, there should be criminal prosecutions long before an inquiry can progress.

Angela Rayner: My hon. Friend is right to capture the mood of the public on this. At a time when the public are told that we have to show restraint, at a time when they can see the finances—not least because the Government’s former Prime Minister and former Chancellor crashed the economy—it absolutely galls them to think that Ministers were not doing the due diligence that was required with the funds we needed. Now we have a situation where we are spending billions of pounds on wasted PPE and we also have thousands of pounds every single day being wasted on storage for PPE.

Kieran Mullan: Obviously in government you have to get on and make decisions, and we do not often get to see what the Labour party would do in our place. On this occasion, we did have an insight because the Labour party recommended a whole series of people who could supply vital supplies for us during the pandemic, including a football agent supplying ventilators. What assessment has the right hon. Lady made of the quality and credibility of the Labour party’s own suggestions for supplies during the pandemic?

Angela Rayner: I thank the hon. Member for his comments, but I ask him: how many Members from across the House who were not Conservative Members got access to the VIP lanes? I can give him the answer: none, zilch, zero. That is the problem. The due diligence was not done on those contracts and it was his Government’s problem, his Government’s responsibility and his Government’s failure.

Nia Griffith: My right hon. Friend is making an excellent speech. Does she agree that there is a huge contrast in the comments of the National Audit Office on the way the Welsh Government procured PPE, in that they did not waste public money and they did get value for money. They did not end up having to explain to the House how they gave contracts to various people. Does she not agree that that is the way a Labour Government in action really works?

Angela Rayner: I absolutely agree. This was a global pandemic, yet it is the UK Government who are constantly criticised about these contracts and the way in which they were doled out and given. All the motion today asks for is transparency. What have they got to hide?

Neale Hanvey: I thank the right hon. Lady for giving way; she is making a powerful speech. Today has been a really important day, because we have met members of the Fire Brigades Union from across the country who have come down to stand up for a decent salary. That is all we are asking for. What this debate illustrates is that the Government can find billions of pounds to hand over in a crisis to well-connected supporters. If the allegations about the Member from the other place are true, enough  money from that alleged dividend would have settled the firefighters’ settlement in Scotland in totality—one person against every firefighter. Will the right hon. Lady confirm that an incoming Labour Government will investigate this matter thoroughly and transparently, and hold anyone who has bent the rules—however they have done so—to justice?

Angela Rayner: I thank the hon. Member for his point, and he is absolutely right. The Fire Brigades Union members were in Parliament and outside it today. They are frustrated, like many others who have been told that there is not money to give them a pay rise and that, actually, they are going to get a real-terms pay cut. But at the same time, billions of pounds has been wasted. As I said in my opening remarks, £770,000 a day has gone on storing this equipment. It is not acceptable to most people and most members of the public.

Meg Hillier: My right hon. Friend has highlighted one particular legal situation, but I am sure she is aware that the Department of Health and Social Care remains in dispute on 176 contracts for PPE worth £2.7 billion. I wonder whether she has any thoughts about that.

Angela Rayner: The Chair of the Public Accounts Committee is absolutely right. It is absolutely eye-watering and astonishing that 176 contracts remain in this situation. The public can see that and they are frustrated, because it is not acceptable and not okay to govern in that way. The public rightly want answers, and they want them now.
The links between the company Medpro and the Tory peer in question were never publicly disclosed. In fact, they were denied repeatedly by the lawyers acting for those involved. We now know that the money ended up in offshore accounts directly linked to those individuals. By their own admission, this was for so-called tax efficiency. It seems that they even dodged paying their own taxes on the profits they made from ours. Only after a long legal battle was it revealed that there was active lobbying from ministerial colleagues for access to the VIP lane and substantial contracts were won by those companies. They said that the peer in question did not benefit from these contracts. That denial has been rather undermined by the latest revelations of The Guardian, rather than any disclosure of Ministers. It was only some time after The Guardian exposed those links that a Minister, the right hon. Member for Charnwood (Edward Argar), finally told me in answer to a parliamentary question:
“Departmental records reflect that a link between Baroness Mone and PPE Medpro was clear prior to contracts being awarded.”
But Ministers have, for months, refused to show us those records or tell us the nature of that link and whether it was declared or discovered in due diligence.
This was the subject of an investigation by the Standards Commissioners in the other place, yet it appears that Ministers sat on the information that they had. The question is very simple: what have Ministers got to hide? Did they know all along who was behind PPE Medpro, or was due diligence so poor that they did not realise the problem? If they had nothing to hide and no rules or laws were broken, Ministers will surely be happy to make the details of the meetings and correspondence available. While they are at it, will the Minister give us  clarity about allegations made by the former Health Secretary in his new book about a separate bid for business connected to Baroness Mone?

Rosie Winterton: Order. The right hon. Lady is venturing rather too far into the territory that I urged her to avoid. I am afraid that those are the rules, so I have to pull her up if she is actively criticising a Member of the other place. I am sorry about that, but those are the rules.

Angela Rayner: I was not criticising Members from the other place. I am just quoting what a Member from this place, who was a Health Minister at the time, said. I am asking this Minister today if he can give us clarity on what was said, because that is now on the public record. That is all I am asking the Minister for. I have not said that about any person from the other place—that is what a former Minister said in his diaries, so it would be nice if this Minister can give us some light on this whole murky affair.
Let us turn to the numbers because, as they say, the numbers don’t lie. Ten: how many times more likely to get a contract a company was if it was in the VIP lane. One in five: the proportion of emergency contracts handed out by the Government that have been flagged for corruption. Three and a half billion: the value, in pounds, of contracts given to the Tory party’s mates—that we know of. Three billion: the value, in pounds, of contracts awarded that warrant further investigation. None, zilch, zero: the number of times this Government have come clean about this dodgy Medpro scandal. A cover-up, a whitewash, events swept under the carpet—and now they have been dragged kicking and screaming to the House today to give an honest account of their shameful dealings. The public are sick of being ripped off and taken for fools. They want to know the truth.

Lloyd Russell-Moyle: Is it not now clear to the public that the Conservative party believes in one thing only: how much money it can grab from the public purse, give to its cronies and friends, and steal from the pockets of hard-working people in this country?

Angela Rayner: My hon. Friend captures the mood of the public. They want answers—they want to know what happened to their money and what happened with these contracts at the time they most needed the Government to act responsibly—so we have tabled today’s motion and will put it to a vote.
Let me be clear. We are not asking the Government to do anything that would undermine any chance of recovering our money or anything that would conflict with any police investigation, but for 10 months they have told us that they are in mediation. What progress has been made? When will they conclude that the mediation has failed and take action? Can they actually get our money back or are they just kicking the can down the road?
Our motion asks Ministers to hand the records over to the Public Accounts Committee—a body that this House relies on to hold them to account for public spending—because the only logical conclusion is that they do indeed have something to hide. The public deserve answers on whether the dodgy lobbying at the  heart of this scandal played a part in how vast sums of taxpayers’ cash have been wasted and whether shameful profiteering has been enabled by this Government.
That leads me to my second simple question for the House today: will Conservative Members—the few who are in—now vote for a clean-up or for yet another cover-up? Just last week, the Government led Tory Members in the other place through the Not Content Lobby to block amendment 72 to their Procurement Bill, which would have banned VIP lanes in future procurement decisions. They voted it down. They voted to protect unlawful VIP access instead of protecting taxpayers’ money.
The Prime Minister, fresh from writing off the billions he carelessly lost to covid fraud, is peddling legislation full of loopholes that would give Tory Ministers free rein to do it all over again. The question for the House is whether to act to prevent a repeat. Today, I say to Conservative right hon. and hon. Members: “Learn your lesson. Don’t let this shameful episode be repeated.”
The loss and trauma of the pandemic were immense. Millions of families lost loved ones—some only got to say goodbye via an iPad as mothers, fathers, husbands, wives and friends slipped away—and then we learned that throughout that trauma, companies with WhatsApp links to Ministers were given special VIP access to contracts that have seen billions poured down the drain.
This Government have done untold damage to the public’s faith in politics. The first step in restoring trust is publishing these documents today. The public need answers about how this happened and they need them now, but they also deserve reassurances that it will never, ever be allowed to happen again. Taxpayers’ money must be treated with respect, not handed out in backroom deals to cronies or used as a passport to profiteering.
PPE Medpro is just the tip of the iceberg in this scandal. We now know that companies that got into the VIP lane were 10 times more likely to win a contract. We now know that many did not go through the so-called eight-stage process of due diligence, as Ministers have now admitted, and we now know that this left dozens of experienced British businesses out in the cold—businesses that had the expertise to procure PPE and ventilators precisely and fast; businesses that offered their help in our darkest hour; businesses whose only mistake was to play by the rules.
Not a single one of the companies referred to the VIP lane was referred by a politician of any political party other than the Conservative party. The then Chancellor of the Duchy of Lancaster, the right hon. Member for Surrey Heath (Michael Gove)—the Cabinet member who oversaw the entire emergency procurement programme —reportedly fast-tracked a bid from one of his own personal friends and donors, who went on to win hundreds of millions of pounds of public money. Last week, he said he had simply referred the bid from PPE Medpro to officials; but we also know that he passed it on directly to his ministerial colleague Lord Agnew.

Dawn Butler: My right hon. Friend is making a thoughtful speech which puts every Conservative Member to shame. Is she as shocked as I was to learn that a company was put into the VIP lane by mistake, and still received a £1 million contract?

Angela Rayner: It is absolute negligence and neglect of due diligence in the whole process. We now know that the issue of the VIP access lane and what it did and did not do has been tested in the High Court, but we also know that there is serious concern among members of the public, and that is what the motion is about. It is about getting to the bottom of it, and I think the public deserve no less than that.
As I was saying, the Minister passed the bid directly on to Lord Agnew. Some time later, officials discussed the fact that the Ministers’ offices were still being furiously lobbied. The former Health Secretary has also described being lobbied in words that I cannot quote in the Chamber—you have made that clear, Madam Deputy Speaker—but without giving any dates or details, so we do not know exactly what conversations or contacts happened behind the scenes. However, we do know that £3.5 billion of contracts have been handed out by this Government to their political donors and Ministers’ mates, so yes, we need an investigation into that as well. In fact, we need an investigation into every pound and penny that has been handed out, and to learn the lessons so that public money is not wasted again.
We should not forget that Ministers had previously denied the existence of a VIP lane. Well, it existed all right. It allowed Conservative politicians to “open doors” for anyone with connections to Ministers. It was the WhatsApp highway express, and earlier this year the High Court declared it unlawful.
As my hon. Friend the Member for Llanelli (Dame Nia Griffith) said earlier, it did not have to be this way. Governments across the world responded to the covid emergency without wasting billions of pounds of taxpayers’ money and relying on dodgy backroom deals. According to the watchdog, the Welsh Labour Government managed to prevent health and care bodies from running out of PPE. The watchdog said:
“In contrast to the position described by the…National Audit Office in England, we saw no evidence of a priority being given to potential suppliers depending on who referred them.”
The Welsh Government created an open and transparent PPE supply chain, which is in stark contrast with the approach that the Conservatives took in England.

Angela Eagle: My right hon. Friend is making a powerful speech. With the benefit of hindsight, does she agree that the House would not have allowed the Government to have the emergency procurement powers that it granted at the beginning of the pandemic if we had known that they would be used in this corrupt manner?

Angela Rayner: My hon. Friend is absolutely right, and I would go further. I know from the correspondence I have been receiving that the public feel that way, and that many Conservative voters are absolutely shocked by what they have seen this Conservative Government do. They do not believe that the Government speak to their values, yet this has happened and we have a Procurement Bill going forward where this could happen again. So for today at least, the question before the House is simple: clean-up or cover-up?
I know that Members across this House care about our democracy, and although we disagree on many things, I hope we agree on the importance of trust in politics, the values of integrity, professionalism and accountability in public office and the public’s wish for  more transparency and accountability within these four walls. Put simply, a vote for this motion is a vote in favour of the truth. This Government have presided over scandal after scandal engulfing their party. They appear to have benefited from dodgy lobbying, left, right and centre. Voting today for yet another cover-up will send another clear message to the public that this Prime Minister cares more about protecting vested interests than putting things right, and that his own promise of “integrity, professionalism and accountability” is just more hot air. After what they have put the British people through, this surely cannot be the message that Conservative Members want to send.
Labour has a plan to turn this procurement racket on its head and tackle the obscene waste with an office for value for money, to ensure that public money is spent with the respect that it deserves. It is about time that Conservative Members got with that programme. So I say today—I hope Conservative Members are listening—let us end the cover-up and begin the clean-up, and let us start it now. I commend this motion to the House.

Rosie Winterton: I know that hon. and right hon. Members heard what I said previously. I just want to add that while these matters are not sub judice, they are under investigation by law enforcement agencies and the Lords Commissioners for Standards, and nothing should be said to prejudge or prejudice any investigations. I am sure that that will be borne in mind.

Will Quince: I am grateful for this opportunity to come to the House to talk about our vital national efforts on personal protective equipment. Colleagues must cast their minds back to where we were three years ago as we stood on the precipice of a global health emergency, the likes of which had not been seen for over a century. SARS-CoV-2 was not even called covid-19 at that point, and little was known about its impact and transmission. In a matter of a few short weeks, this novel coronavirus pushed global health systems and global PPE supply chains to near breaking point, yet here at home, from a standing start, we initiated work on one of the toughest logistical challenges ever undertaken in peacetime: the provision of PPE for frontline colleagues in health and social care.

Neale Hanvey: At the beginning of the pandemic in one of my first Prime Minister’s questions, I asked the then Prime Minister if he would ensure that profiteering would have no place in this Government’s response to the covid pandemic. Now, when we fast-forward to all these years later, that seems to have been at the very heart of it. The British people were told that this Government were helping them. British industry was told that it was going to be supported. I have persisted in my questions about how the domestic diagnostic industry has been promised work by this Government, yet it is being charged for doing the right thing. Will the Minister apologise—

Rosie Winterton: Order.

Will Quince: I will come on to many of the points the hon. Gentleman has raised, but I will just say this about UK supply chains. At the beginning of the pandemic,  only 1% of PPE used in the UK was produced here. At present, three quarters of the FFP-3 masks provided to the NHS and social care are now manufactured in the United Kingdom and contracts were signed with around 30 UK-based companies to manufacture around 3.9 billion items of PPE.
Colleagues will recall those early days, with planes being turned around on the tarmac, countries imposing export bans, huge inflation in global prices and the price of crucial items such as glass increasing sixfold. These were the conditions under which tough decisions were taken, and these were the decisions under which PPE was procured. These were the conditions under which we stepped up to protect our most vulnerable and to save lives.

Karl Turner: How can the Minister possibly square the fact that Arco, a leading clinical PPE supplier to the NHS since its inception —the company has existed in Hull for more than 100 years—did not get a sniff of a contract from the Department of Health and Social Care because it was nowhere near a VIP lane? He should be saying sorry from the Dispatch Box, not all this nonsense. Just ‘fess up and say sorry.

Will Quince: There were lots of words there, and lots of aggression. [Interruption.] Let us be frank, there was.
I will address many of those points. I fear the hon. Gentleman forgets the pressure under which civil servants were working at the time and the pace at which decisions had to be taken. [Interruption.] If he would like to write to me with those exact conditions—

Karl Turner: rose—

Rosie Winterton: Order. The hon. Gentleman must allow the Minister to answer. It is not fair to shout back as soon as he starts answering.

Will Quince: The hon. Member for Kingston upon Hull East (Karl Turner) will know that civil servants had to take decisions about speed, pace and quantity. They were looking at contracts that would get the most amount of PPE for the best value for money as quickly as possible.

Simon Hoare: Was everything that was done, done perfectly? No, and no doubt all the lessons will be learned but, as the Minister says, we would all be well advised to remember, because it was a long time ago now, the absolute panic and fear. The whole world was trying to buy any of this stuff they could get hold of at any price. If we neglect to remember the doctors, nurses and care home operators in our constituencies who were knocking on our doors asking for emergency help, we cannot have a proper debate about this issue.

Will Quince: My hon. Friend is absolutely right. Under those circumstances, in those conditions, we had to be quick and decisive to protect colleagues on the frontline so that they could continue providing life-saving care. With lives on the line, of course we had to change our approach to procurement and adjust our appetite for risk. I do not believe the British people would have  forgiven us if we had stuck to the same old processes. We had to balance the risk of contracts not performing and supplies being sold at a premium against the real risk of harm to the health of frontline workers, the NHS and the public if we failed.

Kieran Mullan: Does my hon. Friend agree that the Opposition want to have it both ways? They criticise us for our procurement decisions but, as I said earlier, they recommended a football agent to supply ventilators, and the Labour Welsh Government procured PPE from the same Serco company that they criticise us for procuring PPE from,

Will Quince: I am keen not to get into a political slanging match on this point, but my hon. Friend is right that all Members on both sides of the House were receiving multiple emails from people who, as my hon. Friend the Member for North Dorset (Simon Hoare) said, were panicking because they wanted to ensure that we procured PPE as quickly as possible.
Colleagues across Government and beyond worked day and night, taking tough decisions, to keep our country safe. Those efforts secured billions of items.

Dawn Butler: On civil servants, will the Minister give way?

Will Quince: No. I will come to civil servants in a moment.

Several hon. Members: rose—

Rosie Winterton: Order. The Minister has indicated that he will give way shortly. Let him make a bit of progress.

Will Quince: I have given way equally to both sides so far in this debate. I have some reluctance to give way to Members who tell others to sit down while they are speaking or making interventions.

Dawn Butler: But are you giving way?

Will Quince: I said I will, and I will.
The efforts of civil servants secured billions of items and, by June 2020, we had obtained 30,000 ventilators and delivered more than 17.5 billion items of PPE to protect frontline workers. What does this mean in practice? It means that we were able to keep our NHS open throughout the pandemic; emergency operations went ahead; and once some of the toughest restrictions were eased, relatives could visit their loved ones in and around care homes.

Dawn Butler: I want to take the Minister back to where he mentioned civil servants. According to the Government’s own records, civil servants were begging Ministers not to give contracts to some of these companies because they had red flags and they were overcharging the Government—we are talking about almost double the price they agreed to be paid. This was an extra cost of £50 million to taxpayers. Civil servants were begging the Government not to act in the corrupt manner that they did.

Will Quince: I am pleased that the hon. Lady made that intervention, because it is the first I have heard of such an accusation being made. If she has evidence of such, I suggest that she presents it.
It might be helpful if I just talk through the process. Thousands of companies made offers; around 430 were prioritised through the high-priority lane; only 12% of those resulted in a contract; and due diligence was carried out on all companies by civil servants. Financial accountability sat with a senior civil servant, and Ministers—this is important—were not involved in the decision-making process. A team of more than 400 civil servants processed referrals and undertook due diligence tests.
On that basis, we will make no apology for procuring PPE at the pace and volume we did. Now that the global market for PPE has stabilised, it is easy for some people to point to the value of goods that are inevitably now sold at a much lower price than we paid, but that is a cheap shot, and one that entirely misses the point. We adjusted down the value of our PPE holding as market prices have changed—that is just standard accounting practice—and even then, we are still putting large quantities of it to use. Our successes should be judged on the conditions we faced at the height of the pandemic, not with the convenient benefit of hindsight.
Let me come to civil servants. If I may, I will give the right hon. Member for Ashton-under-Lyne (Angela Rayner) the benefit of my fast-approaching four years’ experience as a Minister. We rely on hard-working civil servants; they are the backbone of our state and it is my privilege to work with them. She knows that Ministers were not involved in the decision-making process for PPE procurement, and the due diligence, as I have said, was undertaken by a team of more than 400 civil servants. Although I am a Health Minister now, I was not at the time; I was a Minister at the Department for Work and Pensions. I recall how hard civil servants worked, under the most trying conditions, during the pandemic.

Meg Hillier: rose—

Will Quince: I promise I will come to the hon. Lady.
Those 400 civil servants working on PPE and a senior accounting officer took decisions at pace and under huge pressure, as lives depended on them. Did they get everything right? No, they did not. But they did try their best in a highly competitive global market, with significant challenges in sourcing, procuring and distributing PPE. [Interruption.] Yes, they absolutely did. I gently say to the right hon. Member for Ashton-under-Lyne that her implied criticism of their professionalism, integrity and independence at a time of crisis, with the convenience and luxury now of hindsight, is deeply regrettable.

Angela Rayner: The Minister is being disingenuous to say that. I have never suggested for one moment that civil servants do not do an excellent job and work diligently. But why will he not publish the documents and emails about what Ministers, Tory peers and Tory MPs have been up to during the pandemic and these contracts?

Will Quince: I will come to that. As I said, due diligence was carried out on all companies. Procurement decisions were taken by civil servants. Financial accountability sat with a senior civil servant. I thank and applaud our hard-working civil servants, and I  humbly suggest that someone aspiring to be our Deputy Prime Minister should do the same and not seek to throw them under the metaphorical bus.

Meg Hillier: Very early on, the Public Accounts Committee and the National Audit Office were looking into the issue. We know that it was a rush at the beginning, but we were warning about the problems early on, and still they persisted. There was poor record keeping—frankly, it was a lack of record keeping in many cases. This House gave the Government permission to act fast, but not to act fast and loose, and the Minister just needs to acknowledge that.

Will Quince: I thank the hon. Lady for her intervention, and I will come on to some of the action that we will take. She rightly mentions accountability. Details of the high-priority lane were published on 17 November 2021 and updated in February 2022. This is an important point, because the right hon. Lady, the deputy Leader of the Opposition, suggests that there is some kind of cover-up. If there is, Madam Deputy Speaker, listen to this, because this is some kind of cover up! As I have said, high-priority lane details were published on 17 November and updated in February this year. The National Audit Office has written three reports specifically about PPE. The Public Accounts Committee has held a number of evidence sessions. The Boardman review of procurement has taken place and we are implementing its findings in full. The independent public inquiry into the Government’s handling of the pandemic is ongoing. Of course there are lessons that we have to learn, and that we can and should learn, but there is clear accountability in this process.
As I have mentioned civil servants, I want to put on the record my thanks to the 400 civil servants who worked tirelessly to source deals from around the globe, buying PPE to the highest standards and quality and, yes, for the best value at the time. It was not only them; it was a true team effort—one that was made possible through some incredible collaborations, including everyone from industry to the NHS, and from social care providers to our armed forces. They all played their part and they played it well.
Turning now to unsuitable PPE or potential fraud, it is a simple truth that 97% of all PPE that we ordered was suitable and fit for use, with only a small proportion of the billions of items procured deemed unsuitable. Where that has been the case, we are actively seeking to recover costs from suppliers and we are working to maximise the value from our stockpiles, including using PPE in other settings outside of our NHS. Equally, in those rare instances where there have been allegations of fraud, my Department’s anti-fraud unit has worked quickly to investigate and move to recover costs.
With respect to some of the specific points raised in today’s motion, of the thousands of companies that made offers, around 430, as I have said, were processed through the high-priority lane, and only 12% of them resulted in a contract award. The right hon. Member for Ashton-under-Lyne knows that all contracts went through the same due diligence process regardless of the source of the offer. She also knows that the NAO has written three reports about PPE, and the Public Accounts Committee has held a number of hearings. I know that she would like me to go into the detail of  individual contracts, but she knows—she even alluded to it—that my Department is engaged in commercially sensitive mediation with the relevant companies with a view to resolving the issue without recourse to formal legal action.
Responding specifically to the terms of the motion, the Government are committed to releasing information when all investigations are concluded. Our response will necessarily take into account the wider public interest and the commercially sensitive nature of the material. It is only right that we work with the Public Accounts Committee on the terms on which information might be shared. I understand that the Chancellor of the Duchy of Lancaster will soon begin a dialogue with the Chair of the PAC on how we enact those information-sharing arrangements.

Meg Hillier: I thank the Minister for giving way again. I reassure him and the House that the Public Accounts Committee is responsible, not reckless. We have previously received papers from this House and we have a well-established protocol for receiving and dealing with such papers. The Committee is trusted—we never leak. If we decide to publish, that is a choice that we would make, but it is a responsible decision that we would take.

Will Quince: I thank the hon. Lady for that response, and I know the Chancellor of the Duchy of Lancaster will soon begin that dialogue with her.

Dawn Butler: Will the Minister give way?

Will Quince: I have given way once before—

Eleanor Laing: Order. The hon. Lady should not be on her feet when the Minister is answering an intervention from another Member. She is simply getting in the way of the dialogue, and that is not the polite way to do it. If her intervention is to be taken, it will be taken in due course. Standing up for a long time while there is another dialogue going on is really not very polite.

Will Quince: Thank you, Madam Deputy Speaker.

Dawn Butler: rose—

Will Quince: I have given way to the hon. Lady once already, as I promised I would, and I have been generous with my time, so I will not give way again.

Karl Turner: rose—

Will Quince: I also gave way to the hon. Gentleman, so let us leave it.
We should be proud of the remarkable progress we have made on PPE. We are now confident that we have enough stock to cover all future demands arising from covid-19. The right hon. Member for Ashton-under-Lyne mentioned some figures in relation to storage costs, and I am pleased to say that those are now significantly reduced—I will write to her about the cost of storing that PPE here in the UK.
Moreover, we have strengthened our country’s PPE supply chain for the long term, including manufacturing more PPE here in the UK. Before the pandemic, as I said at the beginning of my speech, just 1% of our PPE   was produced here. Now the Government have awarded contracts to around 30 manufacturers for the supply of almost 4 billion items of PPE.
We have learned many lessons from this pandemic, and when it comes to PPE we are on a stronger footing today than ever before, but the successes of our enormous national effort at a time of unprecedented national crisis deserve to be recognised. People from all walks of life came together to protect people in the NHS and social care, and in doing so they saved lives. Even as we continue to learn and to build a system fit for the future, this Government will remain enormously proud of everything that was achieved.

Brendan O'Hara: It is a pleasure to follow the Minister’s robust performance. He said at the end that the Government have learned many lessons. Lesson No. 1 appears to be, “Apologise for nothing.” He knows that no one I heard was criticising the civil servants. Everyone on the Opposition side of the House knows that the civil servants were working in impossible conditions—conditions created by this Government.
I can understand why the Minister has been told to come out swinging and apologise for nothing. Let us be honest: from the moment we first learnt of the existence of the VIP lane for the politically connected, it was inevitable that it would come to this, with Members of this House discussing the eye-watering sums of public money that was earmarked for procuring vital PPE during the pandemic but instead found its way into the hands of fly-by-night chancers who had little or no knowledge or experience of PPE procurement, but who—and this is probably the most charitable thing I can say about them—became fabulously wealthy while making an absolute pig’s ear of it while trying to learn on the job.
Long before the PPE Medpro scandal broke, many of us were already trying to work out how the brains behind this “get rich quick” scheme ever believed that a plan in which the Government would fast-track their cronies, their politically connected pals and now, it would appear, their parliamentary colleagues was ever going to end well. I suspect, as I said during the urgent question on 24 November, that the shocking allegations that have been levelled against PPE Medpro in both The Guardian and The Times—allegations that lead directly to a Member of the other House—may well be the tip of a very large iceberg.
I suspect the reason the Government have been so reluctant to release the papers containing the advice, the correspondence and all the communication between Ministers and special advisers relating to the awarding of that contract is that they do not want to create a precedent that would require them to open the Pandora’s box that is the VIP lane for PPE procurement. However, the Minister would do well to remember that there is another precedent here. The similarities between today’s motion and the motion of 17 November last year, when the Government were instructed to release the papers in relation to the Randox/Owen Paterson scandal, are striking. They will also recall how that scandal rumbled on for two and a half months into February, before the papers were finally made available. Similarly to last year’s debate, the same very simple questions go to the  heart of today’s: do this Government have something to hide? Is there something this Government do not want us to see?
The Minister must be aware that the more the Government dodge scrutiny, so public suspicion will grow about this PPE procurement programme being little more than a get-rich-quick scheme for their politically connected pals. Given what we already know, who can blame the public for thinking that? Byline Times recently said that the covid contract winners with direct links to the Conservative party—donors and associates—have seen their collective financial position improve by in excess of £300 million. Was anyone really that surprised when Private Eye described how
“The DHSC’s London-controlled PPE ‘cell’ was dishing out contracts like confetti to opportunistic businessmen”?

Kieran Mullan: What would the Scottish public think about the Scottish Government awarding PPE contracts, without competition, to more than 20 brand-new suppliers that were unknown to the Government?

Brendan O'Hara: I hate to say it, but my goodness you are predictable, Sir. That was probably the most predictable question I could ever have imagined. I will come to that later in my speech. Compared with what went on in this place, the audit of the Scottish Government’s treatment of the procurement process is squeaky clean. I so look forward to having that conversation in about six minutes.
Many of those opportunists hit the jackpot in the Government’s VIP lane for PPE procurement. Prominent among them was PPE Medpro, whose bid to supply the UK Government with face masks and surgical gowns was in the high-priority lane after, we are told, some particularly enthusiastic lobbying was carried out on its behalf by someone down the corridor. Indeed, the peer in question was so enthusiastic about the abilities of PPE Medpro to deliver that she made her passionate pitch to Ministers before the company was even incorporated. Through remarkable powers of persuasion, she persuaded Ministers to propel that embryonic company—one with no experience in delivering medical or protective equipment, and one with which, she told them, she had no personal involvement and from which she did not stand to gain financially—straight into the VIP lane.

Eleanor Laing: Order. I remind the hon. Gentleman that he is in danger of straying. I have let it go so far, but I remind him, as I remind the House, of what the Deputy Speaker said at the beginning of the debate. The normal rule—that reflections must not be cast upon Members of either House of Parliament, except on a substantive motion, which this is not—remains in force. I know that the hon. Gentleman will be careful in what he says.

Brendan O'Hara: Thank you, Madam Deputy Speaker. I will attempt to stay on the right side of that line, and I am sure that you will instruct me should I stray again.
On 25 June 2020, just 44 days after PPE Medpro had been legally incorporated, the firm was handed its first UK Government contract, worth almost £81 million, for the supply of face masks. Very shortly thereafter,  it was awarded a second contract, worth in excess of £120 million, to provide 25 million surgical gowns. Earlier this year, The Guardian reported that it had seen the contract that was signed between PPE Medpro and the gown manufacturer in China. The price that PPE Medpro paid for the gowns was just £46 million, and even adding a bit for shipping, logistics and storage leaves, by any reasonable calculation, a whopping profit of around £70 million of public money from a contract worth £120 million.
To add insult to injury, when the cargo of gowns finally arrived, a quick technical inspection from the national health service deemed them not fit for purpose and they were never used. I understand that the situation is so serious that the company is currently under investigation by the National Crime Agency, but inexplicably, up until a couple of hours ago, the peer involved was still operating under the Conservative party Whip. As the right hon. Member for Ashton-under-Lyne (Angela Rayner) said, this stinks. We know it stinks and the public—

Eleanor Laing: Order. I am quite sure that the hon. Gentleman intends to talk just about the process and the goods and so on, and that he will not be mentioning any peer in particular. He said “the peer involved”, so he referenced not just peers in general, but a particular peer. I am sure that he does not want to make reference to any particular peer, but will just talk about the process.

Brendan O'Hara: I shall from now on, Madam Deputy Speaker; thank you.
This whole process stinks, and we all know it does. That is why we have to see what this Government know. They deliberately created the conditions in which such behaviour could flourish, and they have to release what they know.

Peter Grant: May I take my hon. Friend back to his comments earlier about due diligence? We all heard the Minister a few minutes ago claiming that due diligence was carried out in every single case. Is it possible for even the top civil servants in the United Kingdom to do any sort of due diligence on a company that did not exist two or three weeks before?

Brendan O'Hara: That is an excellent question, and perhaps it is a question that, had my hon. Friend managed to intervene on him, the Minister would have been far better placed than I to answer. I find it remarkable that due diligence can be carried out on a company that did not exist.
The Government know that the release of the PPE Medpro papers will not make this magically disappear, and they are right to fear that, in releasing those files, they are likely to blow the lid off this Pandora’s box and reveal that their VIP lane for politically connected pals was simply a green light for unfettered crony capitalism, rampant profiteering and widespread abuse of public funds.
In his answer to the question on 24 November, the Under-Secretary of State for Health and Social Care, the hon. Member for Harborough (Neil O’Brien), told this House:
“There was a global scramble for PPE…It was an extraordinary situation in which we had to act in a different way.”—[Official Report, 24 November 2022; Vol. 723, c. 441.]
It is a defence that the Minister today, the hon. Member for Colchester (Will Quince), also tried to hide behind a moment ago. It may be true that things had to be done slightly differently, but what is undeniable is that the UK Government made an active choice to act in the way that they did. It was a political choice to make this an all-in, free market jamboree. They did not need to do so. [Interruption.]
In response to the chuntering from the hon. Member for Crewe and Nantwich (Dr Mullan), the Scottish Government acted in an entirely different way. Many items of PPE for Scotland had to be sourced from overseas, but the big difference and—[Interruption.] If the hon. Member will stop talking and listen, I will explain. The big difference was that our Government sent staff from Scottish Enterprise over to China to source the items we needed and to ensure they were made to an acceptable standard and delivered at a cost we could afford. At the same time, the Scottish Government were increasingly working with Scottish manufacturers, so that by April 2021, 88% of our PPE was being produced in Scotland.
That Government involvement had a huge impact on the price. Unit costs show that disposable facemasks cost the NHS in Scotland 31p each, while the Department of Health and Social Care in England paid 40p. That is an increase of 29%.

Peter Grant: I can personally vouch for what my hon. Friend has said about the development of the manufacturing industry in Scotland, because there is an outstanding manufacturer in my constituency that did exactly that—its staff came in and worked unpaid over the weekend to reset its production lines to make what was needed, instead of the high-quality stuff it had been producing before. Does he think it is sad that I cannot name that company and sing its praises today, because I do not know whether it would thank me for connecting it, even tangentially, to the subject of this debate? Is it not sad that even outstanding Scottish firms are in danger of being tarred by the same brush that has been applied elsewhere?

Brendan O'Hara: My hon. Friend makes an excellent point. All the good that we could and should be talking about is being lost by this tarnished reputation. He could just as easily have pointed to the Scotch Whisky Association, which pivoted very quickly to turn its alcohol into millions of gallons of hand gel.
I go back to the point that the Scottish Government’s involvement was absolutely crucial in controlling the prices. As I said, disposable face masks were 29% cheaper because they were bought by the Scottish Government directly. The Scottish Government bought FFP3 face masks for £2.08 a unit. The Department of Health and Social Care bought them for £2.51—a fifth higher. Disposable gloves cost the Scottish NHS 9p each. In England, it was 33% higher at 12p. Even non-sterile gloves were bought 10% cheaper by the Scottish Government. One would have thought that a country with one twelfth the population of England would have a real job in pushing unit costs down below those of a country 12 times its size. It goes back to the fact that the approach the Scottish Government took meant they were in control of every part of the process, and they secured the deals they required.

Kieran Mullan: The hon. Member is talking about the Scottish Government’s track record on procurement and value for money. Does he think that that applies across the piece? How well are they doing when it comes to ferry procurement in Scotland?

Brendan O'Hara: It is remarkable—we can always spot when a Tory is sinking beneath the waves when they start shouting “ferries” at us. Let us remember that this is a Government who awarded a ferry contract to a company with no boats.

David Linden: Is my hon. Friend aware, as the hon. Member for Crewe and Nantwich (Dr Mullan) perhaps is not, that the Seaborne Freight ferries contract cost £13 million? Is it not the case that people in glass houses ought not to throw stones from Crewe?

Brendan O'Hara: One would have hoped that people in glass houses, having thrown the first stone, would have realised that it was not the best idea.
Let me put on record that the NHS in Scotland used emergency procurement provisions to award PPE contracts without competition during the first wave of covid-19 but, crucially, the auditors are completely satisfied with the procurement arrangements in place and said that there was
“No evidence of preferential treatment or bias”
in the awarding of contracts in Scotland. I believe that that is the significant reason why our overall costs of pandemic procurement were less than a third of the UK’s, and it perhaps explains why the Government are now paying £770,000 every single day to store PPE in China. The Minister will be aware that I have tabled a series of questions today to ask how much of that PPE is still usable, how much of it meets the standards required for the UK, what quality control methods were used in securing it and the proportion of PPE that did not meet the standard required.

Will Quince: rose—

Brendan O'Hara: I will give way if the Minister can tell us the exact proportion of PPE produced that did not meet the standard in the UK.

Will Quince: I will quickly update the House. As of October, we hold 13.1 billion items of PPE and we have disposed of 145,000 pallets of excess stock so far. The majority is stored in UK sites; about 120 million items are still stored in China. The total cost of storage is now below £400,000 a day, so significantly less than the hon. Gentleman says, and the total cost for storage in China is £35,000 a day.

Brendan O'Hara: I genuinely thank the Minister for that information and I look forward to reading it in Hansard so I can digest it. If I heard correctly, we are now on half a million pounds a day for storing PPE.
In conclusion, having to do things differently does not give anyone, whether they are a private individual, an elected politician or an unelected politician, a licence to rip up the rulebook and behave as if we live in an unregulated wild west of public procurement. That is why it is vital that these papers are released. The public  have a right to know why, while doctors, nurses and other medical staff battled unvaccinated through the worst of the pandemic, and as the public stood and cheered them in grateful thanks, some people with connections to this Government saw only the opportunity to make themselves a quick buck. I predict that this PPE Medpro scandal is the tip of a very large iceberg—an iceberg that will eventually sink this ship of fools.

Nick Smith: I rise to support the motion on PPE, which has become a terrible tail of waste for our country. First, having purchased so much PPE, the taxpayer is now paying to store and, as I have discovered, burn a great deal of it. Secondly, a band of profiteers, some of whom took advantage of their political links, exploited our country’s desperation. Many of those opportunists used chicanery and secrecy to make eye-watering profits. Now, the UK Department of Health and Social Care is withholding information on the cost of staffing its contractual battles with some of those PPE suppliers.
I will address the continuing cost of PPE storage. A Government response to questions I asked last month said that the Department currently holds 13.2 billion items of PPE and the cost of storing that is a staggering £770,000 a day. I was going to go on to some other data, but we just heard an update on that that still works out at, I think, about £128 million a year if we round it up over the year ahead, which is half the cost of a brand-spanking new hospital. That is a disgrace.
We have heard about the modern-day pirates whose business accounts have been almost impossible to trace and track. Thanks to The Sunday Times, we know about a network of companies with connections to Conservative lobbyists, one of which is Sante Global, formerly Unispace Health. Private Eye deserves a medal for digging deeper: its “Profits of Doom” special highlighted how Unispace Global won PPE contracts worth nearly £700 million—Richard Brooks is a fantastic journalist. Reports suggest that it has accounted for its profits through different companies from those known to the Department, so it is impossible to see how much money it has made.
That information is shrouded in secrecy due to our feeble accountancy laws, but the taxpayer deserves to know who is profiting from contracts awarded by the Government with public money for the public benefit. It is high time that this PPE treasure hunt came to an end. We need full, open accounting for covid-19 contracts. These companies should be made to publish full details of their income, profits, commissions, dividends and big boss bonuses. The Chancellor should then consider a windfall tax on their super-profits.
The Government could also learn a lesson in transparency. In my experience, in recent months they have been trying to dodge questions on the continuing cost of PPE. Last month, I asked the Secretary of State for Health how much unused PPE had been donated, sold, recycled and incinerated since the start of the pandemic—no answer yet. I also asked when he planned to publish the forecast of the cost of resolving the ongoing contractual disputes we have heard a lot about today—again, no answer yet.
There are disputed contracts worth £2.6 billion with 176 companies. That amount could buy us seven new hospitals. It is important that the Government pursue this money, so all power to their elbow. However, I think transparency on their processes could help this cause, because the more we all understand, the better we can hold the bad actors to account. We should support the motion as long as the long tail of covid costs continues. The covid contracts need to be cleared up, and the Department of Health must come clean.

Dawn Butler: I have a few points for the Minister of State, Department of Health and Social Care, the hon. Member for Colchester (Will Quince), who is no longer in his place. The National Audit Office did not have all the paperwork it needed to give a full and correct report. Therefore, when the Minister kept quoting the National Audit Office saying that due diligence was done on all companies, that is not correct. Also, the NHS published weekly consumption data during the pandemic, so the question is: how on earth did we come to buy five times more PPE than we actually needed? It makes no sense. There is a lot of evidence and paperwork on the Good Law Project website, just for the Minister’s reference.
The coronavirus pandemic has been a nightmare for everyone. It was a time of national pain and loss, and for some it was unspeakable. People lost loved ones, as I did, and it was also financially damaging for the country. It is absolutely shocking and unforgivable that some people saw this crisis as an opportunity to seriously line their own pockets, making money out of the misery we all went through. Let us be clear: this money is not free money. This money comes from working people through taxation, and the Government have been pickpocketing the working class to fund the lifestyle of the rich.
We still do not know the true extent of the misuse of public money, and that is why this motion is important. Even though I and many others have been asking questions for three years, what comes back from the Government is really quite sparse. We are having to piece together the information, and that is not good enough from a Government. They need to be transparent and honest, and the public deserve to know who was given public funds, how many had links to the Conservatives and what they were paid for. I often ask, “What were they paid for? What kind of PPE? How many, and how many did we receive?” The Minister never comes back with that information, so if the Minister has the facts and figures, broken down for each company, I would appreciate if he put that in the Library. According to the Minister last week, some companies were paid for PPE even though we had enough PPE in stock. I said, “Was that deliberate?” and he said yes. I think that is really quite strange—if we have enough PPE, why are you giving people more PPE?

Neil O'Brien: The hon. Member claims that we bought five times too much PPE. This is not the case. We did have 20% excess capacity against a worst-case scenario that, thankfully, did not materialise. But just to be clear to her, it is not the case, as she keeps saying, that we bought five times too much PPE. That is simply not the case.

Dawn Butler: I thank the Minister for that intervention. So can he just clarify: if the NHS was given weekly stats on how much PPE was needed, how come there is so much PPE in storage, which is costing £750,000 a day to store? Does the Minister want to come back? Oh, the Minister of State has walked in at the right time.

Neil O'Brien: The Minister of State did actually give the House some updated figures on that point. It is not the £750,000 figure the hon. Member just quoted. On this point, it is not the case that we bought five times too much PPE. She keeps saying that. It is not the case.

Dawn Butler: I suppose the facts will reveal themselves when the Minister shows us all the paperwork, leaves it in the Library and then we can go through the facts, the stats and the figures together. I look forward to that. We heard earlier today—[Interruption.] The Ministers are going through some figures now. I really think that, to resolve all of this, and to not even have this debate and conversation, they should put all the paperwork in the Library, we can all go through it together and that is what is needed.

Sarah Owen: My hon. Friend is making a powerful speech and she has spoken with incredible experience and heart on this subject throughout the last few years. Does she agree it is particularly galling that we are seeing the former Health Secretary write a book, the “Pandemic Diaries”, yet we are not able to scrutinise the facts and evidence of the decisions that were taken not just about the public’s money but about public safety?

Dawn Butler: My hon. Friend makes an extremely valid point. I spoke in Committee this morning. I am not going to read the book but I think we have to scrutinise it and cross-check the information that the Minister gave in Committee against what is in the book. The new Ministers who have come into post should be a little more humble, because what has happened is shocking. The cronyism and the corruption that has happened in the Government in plain sight is truly shocking. The Government are now spending £10 million burning PPE. It is like they are burning the evidence—we wonder why. [Interruption.] Sorry, the Minister said that I have just criticised the Minister for storing PPE. He is right. I would not want the Minister to spend nearly £1 million every day storing PPE. I also do not want him to burn PPE. He should be using the PPE—give it to people who are travelling on the tube. We are having a flu epidemic and it will help to resolve that, so don’t heckle me when this is your responsibility—[Interruption.] I mean the Minister. Sorry, Madam Deputy Speaker. The Government are incompetent as well as corrupt and it  is not just cronyism. The situation is so ridiculous—[Interruption.] Am I not allowed to call it what it is, Madam Deputy Speaker? It smells like corruption to me.

Eleanor Laing: Order. It is perfectly in order for the hon. Lady to say “incompetent”, but I would be grateful if she would find another form of words, rather than saying “corrupt”.

Dawn Butler: This is so ridiculous, Madam Deputy Speaker. When the Netflix series comes out, nobody is going to believe it is a true story. I know we are not supposed to speak about the Conservative peer too  much, but we learn today that they are taking leave of absence from the Lords. I am not saying this in jest, but I hope she is not on her yacht trying to do a runner because a lot of money has gone missing. In a previous Minister’s own words, he was being “bullied” into giving this contract—[Interruption.] No, I don’t feel sorry for him, but he was being bullied. Two Ministers were being bullied, so it is important that we investigate the VIP lane.
As I said earlier, the National Audit Office said that companies were put there by mistake and were still given millions of pounds. Surely that shows us that due diligence was not done; the company was there by mistake. How did it get all that money? When the Minister gets to his feet, could he tell the House how many of these companies existed before the pandemic? If he cannot, of course, we look forward to that information being available in the Library or when this motion passes today, which I hope it does.
For the avoidance of any doubt, we all know that the VIP lane was a bit dodgy—that is just a fact and on record—but this has all come to light not because Parliament managed to force the Government to reveal everything that happened, but because a bank reported unusual activity and dropped a certain person and her husband in fear of reputational damage. That is what has brought this particular scandal to light and the National Crime Agency has now investigated.
As others have said, this is just the tip of a very large iceberg. The Serious Fraud office is also investigating contracts won by another company, Pharmaceuticals Direct Ltd, which paid a whopping £20 million fee to a middleman, Surbjit Shergill, who worked for Samir Jassal. Together, they had a hotline to the then Prime Minister’s special adviser, Munira Mirza. We also know—we have seen the emails—that they were helped by the right hon. Members for West Suffolk (Matt Hancock) and for Witham (Priti Patel).
If a company has to go through due diligence and believes that it is participating in a proper process, why would it agree to pay a politically connected middleman £20 million? That does not make any sense. If everybody is treated the same, there would be no need to pay somebody £20 million to move up the list. As you said, Madam Deputy Speaker, I cannot say the word “corruption” —I am trying to think of other words; hopefully more will come to me and I will use them—but it feels very much like cash for covid contracts. What happened to that money is a mystery. The Serious Fraud Office continues to investigate the case 18 months after it was referred.
I could speak about so many more cases. For those who are interested, there is a thread on my Twitter account about some of the other companies where there are huge questions to be answered. The Government need to open up their books and ensure that there is proper scrutiny. Yes, of course we accept that mistakes were made and that some of them were unavoidable, but the Department of Health and Social Care did not do the fraud checks that it was supposed to do; we had to push it, and that did not come out until a whole year later. There has been negligence, but there has also been something a little more sinister happening in Government.
Those people who stole money from the public purse during a national crisis should be ashamed. They should not say, “I was doing it for the country” as they are not  when they are pocketing millions of pounds. It is not patriotic; it is a word that you are not happy with me using, Madam Deputy Speaker. Those people took the money unlawfully, really—they were helped by Government Ministers—and they will have had plenty of interest payments from their ill-gotten gains. Now is the time, during the cost of living crisis, to give that money back. That includes the donations given to the Tory party by those people who had a bung from the covid crisis—they need to come back into the public purse.

Eleanor Laing: Order. I will have to put on a time limit of four minutes.

Naseem Shah: As an Opposition, we expect to scrutinise the Government, hold them to account and challenge them on policy and legislation, but never did I imagine that there would be scandals, favours and dodgy deals through a VIP lane. The contract that we are focusing on is the £200 million deal to provide PPE to the Government at the height of the first covid-19 lockdown, awarded to a company allegedly linked to and lobbied for by a Tory peer, who also happened to benefit to the tune of about £29 million transferred to an offshore account linked to her and her adult children.
The seriousness of the case is such that, earlier this year, the police raided two London properties linked to the Tory peer as well as four properties on the Isle of Man in support of an ongoing National Crime Agency fraud investigation. We are literally speaking about a criminal fraud investigation whose trail leads directly back to the centre of Government.
The Government line has consistently been that they were doing their best to ensure that the best quality PPE could be secured and used during the covid-19 pandemic. The truth is that they were ripping off the British taxpayer to help their friends’ pockets. In May 2020, Baroness Mone referred PPE Medpro to the Cabinet Office for potential multimillion-pound PPE contracts five days before it was even registered as a company. What track record can a company have to deliver millions of pounds of PPE for the Government when it does not even exist?
In significant contrast, like many businesses across the country, is Multibrands International Ltd, a Bradford-based business in my constituency that provided PPE and was incorporated in 1998. It has had an operation in China since 2006 and a support office in India since 2010. This legitimate and established company was denied the opportunity to provide the Government with PPE. At the time, Multibrands International wrote to me and asked the question:
“What does our Government do for businesses like us? Is it because we are Northern? Or because we choose to operate legitimately? Or is it because we don’t have secret dealings with MPs? We were never given a chance.”
Shamefully, that is the truth: it was never given a chance. Unlike the then Health Secretary’s local mate from the pub, it did not have his WhatsApp number, any other Tory Minister’s private numbers or direct access email to a Tory Minister. Instead, rip-off contracts were given to Tory friends to profit from the British taxpayer.
In my neck of the woods, the idea of mates’ rates is when you generally get a better deal. Usually, it goes something like this. “Well, I’d normally charge you a fiver but because it’s you and you’re a mate, I’ll knock off a few pennies.” In this case, according to documents leaked to The Times, during the pandemic PPE Medpro supplied masks at a cost of 38.5 pence each to the Government. The same masks from the same company at the same time were provided to other suppliers for as little as 14.5 pence. No one rips off their friends, but it was okay for the Tories and their cronies to rip off the British taxpayer. Some £8.7 billion was written off, including £4 billion spent on PPE that did not meet NHS standards.
The National Audit Office revealed that the Department for Health and Social Care paid £436 million in penalties because it had to store PPE. That is more than a year’s budget for my whole local council in Bradford for 2021-22. With the £8.7 billion that was written off, we could have had three hospitals in Bradford—I see the Minister of State, Department of Health and Social Care, the hon. Member for Colchester (Will Quince) is in his place—including the first carbon-neutral hospital and a state of the art hospital in Bradford city centre, replacing two in my constituency.
The British people will not forgive the Government for ripping them off while they suffer through a winter where they choose between eating and heating. Publish your documents and come clean. As the deputy leader of the Labour party, my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner) said when she opened the debate, stop the cover-up and start the clean-up.

Nadia Whittome: The Government’s actions on PPE were a catalogue of failures from start to finish, with devastating consequences. Before coronavirus, the existing PPE stockpile did not include everything it should have. Then the Government were slow off the mark. They took too long to understand that we would need more PPE and failed to get on with ordering it. That meant that in the first wave of the pandemic, those on the front line were left dangerously exposed. I know that because when I returned to care work to help relieve the strain on my former colleagues, I saw at first-hand masks being rationed and visors donated by the public.
When I spoke out about those PPE shortages, Conservative Members insinuated that I was lying. Among them—I have informed them that I will be referencing them—were the Secretary of State for Foreign, Commonwealth and Development Affairs, the right hon. Member for Braintree (James Cleverly), the right hon. Member for Mid Bedfordshire (Ms Dorries), who was a Health Minister at the time, and the hon. Member for Mansfield (Ben Bradley). Despite report after report proving that there were PPE shortages and that I was telling the truth, not one has ever apologised for those comments. It is not me I want them to apologise to, but the millions in the care sector, both staff and the people they were caring for, who were forgotten and neglected by their Government.
The Government put care workers’ lives at risk, as well as the lives of those receiving care. The workers, overwhelmingly women and disproportionately migrants,  earnt poverty wages. Of course, that was not everyone’s experience of the pandemic. While my former colleagues worked day and night for a pittance, with some paying with their lives, the rich saw the chance to cash in. One businessman’s company made a £70 million profit on a contract for PPE that was reportedly not suitable for the NHS, and therefore went unused. He paid himself £13 million and celebrated his birthday last week by eating a cake shaped like a briefcase of cash on a private yacht. Meller Designs was awarded PPE contracts worth more than £170 million. In 2020, it made profits of over £13 million, a 9,000% increase on the previous year. One of the co-owners had donated nearly £60,000 to Conservative politicians and the central party since 2009. Unsurprisingly, the company was referred to the fast-track VIP lane by a Conservative Minister.
Once the Government started ordering PPE, all too often it was not about who could supply the best, the fastest and at a reasonable price, but about who had connections to the Conservative party. Those referred to the VIP lane were 10 times more likely to be awarded contracts. So the Government acted unlawfully, wasted billions of pounds of taxpayers’ money in the process and failed to protect those on the frontline.
We talk about how corruption robs citizens and ruins public services in countries across the world, but when it is happening right here in front of our eyes, we dress it up in euphemisms. I urge the Government to come clean and release all the papers relating to the awarding of contracts to Medpro, and also relating to all contracts awarded through the VIP lane.

Christine Jardine: I rise to support this motion, but the sentiment that I feel most strongly is, “What a mess—what an unnecessary, unmitigated mess.” We have heard a lot from Conservative Members about how difficult it was at the time. We all know that, as we all experienced it. We have heard a lot about having to be quick and decisive and the pressure that people were working under, with lives at stake. I wonder whether the Minister appreciates that that is exactly why people are so angry about this. We all went through it and experienced it.
The thing that we remarked on most at the time was the spirit in the country and how everybody got behind the Government, even those of us whose job it is to scrutinise them. We got behind the Government, and people had faith in, believed in and supported them, but three years down the line, we wake up every morning to yet another news story, another scandal and more suggestions about what might have gone wrong. People feel let down and betrayed.
The numbers are frightening. At one point, it was £2 billion of taxpayers’ money that was wasted on PPE contracts, but we are now told that almost £10 billion was wasted on PPE in total. We hear about PPE being stored and burned. That is not really the issue for the people in my constituency and elsewhere in the country who are struggling this winter to make ends meet, who have massive energy bills, who wonder whether they will be able to feed their children, who are worried about what their mortgages will cost. What is bothering them is that when they were putting their faith in the Government, when they believed the Government that we were in all  in this together, maybe we were not. The suggestion now is that some people were profiting from other people’s pain. That is why, in supporting this motion, I make a plea to the Government to listen to what we are saying. We are not saying that civil servants were wrong. We are saying that people need to know what actually went on. They need transparency.
When the latest Prime Minister first took office he promised us a Government who would be ethical and would have doing the right thing at their heart. We need him to be as good as his word now. We need him to make it clear that he will leave no stone unturned and that his Government will leave no possibility of anything sleazy, of any cronyism or of anyone having profited at a cost to and at the expense of the British public at a time of extreme—and it was extreme—national crisis.
That is why this debate is important, and we need that from the Government now. We need something of the spirit that we had back then when things looked so dark and we were all worried for ourselves, our families, our health and our futures. We need the Government to stick by what the Prime Minister said and to give us transparency. Let us see the papers; put everything out in the open. And please ban VIP lanes, because the very notion that there was such a thing as a VIP lane when the country was in the midst of a pandemic and people were dying is offensive.

Kate Hollern: Members across the House repeatedly warned about the contracts that were being awarded to companies during the toughest days of the pandemic, and especially to companies in the high-priority lane. It was not just about PPE; I raised concerns about testing kits that put residents of care homes in Blackburn at risk.
Our debate today is about the failure of proper due diligence. It was not a harmless failure; it hampered our response to covid and enriched VIP politicians while putting the public at risk. Constituents and companies were eager to help. The support that they offered was tremendous, and it could have saved lives if it had been accepted much, much sooner.
I would like to read from an email from a constituent, the managing director of a medical equipment company in Blackburn. The company, which has been going for 30 years and provides equipment across the world, contacted the Government in March 2020 to offer its services. Six weeks later, it had had no response. Those were six weeks lost. When a response did come, it was pretty miserable: it pointed to a link on the Government’s website. The company never got a proper response. The managing director wrote:
“None of what I am seeing makes any sense, when all this calms down as one day it will the lawyers will have a field day…people are using non medically approved or tested equipment…whilst there are recognised businesses that can supply the necessary approved and tested PPE that are being ignored by government.”
The company was producing PPE for councils and other public bodies that had been let down by the Government.
The scandal has been exposed and it is important that cronyism is never allowed to happen again. Billions of pounds of public money were wasted and lives were lost.  It is disappointing that so few Conservative Members are here to hear about their failures, because you can only learn by your mistakes. They are turning a deaf ear to the scandal. Accountability, openness, honesty and integrity are all on the table this evening. It would be shameful if Conservative Members failed to vote.
This is a call for transparency. We must not fail the public in these situations ever again. We must demonstrate that we have learned from the mistakes. We must demonstrate transparency. If, as the Minister claims, there is nothing to see here and everything has been done properly, I suggest he votes for the motion and promises to put the papers in the Library as soon as possible.

Peter Grant: I certainly support the motion, and I commend the Opposition for devoting part of their Opposition day to it. It is perhaps unfortunate that they did not realise that another very interesting piece of contract lobbying had been carried out. Apparently the contract was not awarded, and the person who did the lobbying was later described by a senior civil servant as “incandescent with rage” that her chosen supplier had not been successful. I do not know whether that incident relates to the same company that we are talking about today, but it is clear that there has been more than one instance of lobbying for very lucrative contracts for well-connected companies.
The Minister referred several times to the fact that the National Audit Office and the Public Accounts Committee have looked at the issue. Well, that’s okay—everything must be fine! I wonder why he did not choose to enlighten hon. Members who have not read the reports about some of the things they say. The NAO report of 26 November 2020 states that
“some procurements were carried out before all key controls were put in place”
and that the Government
“awarded contracts to 71 suppliers, with a total value of £1.5 billion, before the financial and company due diligence process was standardised.”
As for the claim that 97% to 98% of all items were usable, another NAO report records the Department’s estimate that 3.6 billion items—11% of the total, at a cost of £2.9 billion—were
“not currently suitable for front-line services”.
In other words, when we talk about 97% of items being usable, we mean that we might have paid for high-grade, clinical, sterile equipment that someone cutting up wood could use as a face mask to keep the dust out of their lungs. That is not frontline clinical use.
In July this year, the Public Accounts Committee said:
“The Department still”
—two years after the contracts were signed—
“lacks a stock management system that enables it to fully understand what PPE it has and where it is.”
So the Department does not know what it has or where it is. The Committee also said that there were
“insufficient due diligence checks at the outset of the pandemic to prevent potential profiteering and to identify conflicts of interest.”
The exact concerns that Members were raising from day one have been confirmed by the PAC, which concluded:
“We are…unsurprised to see the reports of excessive profits and conflicts of interest on PPE contracts.”
We can only speculate on why the Minister did not find time to refer to any of the content of those reports when he addressed us earlier.
The Minister boasted that 97% to 98% of items were usable, but we should note that he referred to “items” without referring to their value. If you order clinical gloves and get gloves that are not suitable for clinical use, you can still use them to keep the oil off your hands if you are servicing your car, but each of those costs pennies. As we have heard, millions of pounds-worth of “sterile” gowns could not be used because they were not in fact sterile. Why did the Minister choose to give us part of the truth, but not the whole truth?
Failings by the Government have meant that there is, at best, a huge question mark over this whole process, and a question mark over legitimate firms and hard-working professional civil servants, but in some cases—a minority, but some of them significant—those question marks are not in fact question marks, but exclamation marks. It is clear that things have happened that should not have been allowed to happen, and that require further investigation. The Government may have their reasons for wanting to keep this information from—not necessarily only from the public, but from the Public Accounts Committee. That information must be released, and the decision on what is made public and what is kept secret must be left to the judgment of that impartial Committee.

Nia Griffith: My hon. Friends have set out very clearly the shocking scandal of the PPE contracts. They have also mentioned people who were working hard on the frontline, putting themselves in danger to help others; and, of course, all those who lost loved ones. I will concentrate on the damage that the VIP lanes have done to loyal, reputable companies—the backbone of British business—who offered to be generous and go the extra mile to help, rather than looking for chances to rip the taxpayer off.
BCB International, a company that operates in my constituency and in Cardiff, is a long-established manufacturer and supplier of life-saving equipment, including medical equipment. Its primary customers in the UK are the Ministry of Defence, the Ministry of Justice and many police forces, and it exports approximately 40% of its turnover. It makes, for instance, very good fuel for camping gas stoves called FireDragon. It was registered, it was known to the MOD and the MOJ, it had a good reputation, and it was ready to go. In March 2020, it was engaged in the production of its high-quality hand sanitiser, Dr Browne’s, in Llanelli. It employed up to 100 staff, and worked 24/7. The 80% alcohol sanitiser passed all the appropriate tests, and was well liked and used by the NHS in Wales, as well as by a number of police forces and other public bodies.
Owing to the PPE shortages, the UK Government made a commitment early in the pandemic to “back British business”, and their “UK Make” programme,   headed by Lord Deighton, was tasked to unleash the potential of UK industry to scale up domestic PPE manufacturing. In May 2020, Lord Deighton said:
“As countries around the world face unprecedented demand for PPE, British industry is stepping forward to make sure vital pieces of equipment reach our workers on the frontline.
My role is to increase our homegrown PPE supplies, both now and in the future, by investing in the potential of UK manufacturing.”
However, I understand that the “UK Make” policy was withdrawn in September 2020.
In May 2020, following the Government initiatives, BCB invested £700,000 in new hand sanitiser production equipment. It also bought in high-quality FFP3 face masks from Europe, set up gown production, and made oxygen bottle bags. It supplied all those, successfully and on time, to the Welsh NHS, to Welsh and English police forces and to the MOD.
From March 2020, the company regularly tried to sell its British PPE products to the Department of Health and Social Care, and it has provided a brief overview of just some of the names that it was in contact with. I do not have time to read them out now, but the company tells me that although it made these contacts and sent many other emails, it was never contacted back. That is an utter disgrace, and today we have seen why that was the case. There was no need for it to be the case. Good, loyal companies that did everything they possibly could and turned their workforces to working for the country were completely ignored.
As has been mentioned, it was not like that in Wales, and companies have spoken very highly of the Welsh procurement procedure. It is no wonder that the Auditor General for Wales has said:
“In contrast the position described by the NAO in England, we saw no evidence of a priority being given to potential suppliers depending on who referred them.”
Those are extremely strong words, from an auditor referring to what was happening in England. The Welsh Government put in place good arrangements overall. That is such a contrast, and this is what is so damaging to all the good businesses in this country who want to play by the rules.

Eleanor Laing: I call the shadow Minister.

Fleur Anderson: I am delighted to be able to close today’s debate on behalf of His Majesty’s Opposition, and I share the indignation of my right hon. Friend the Member for Ashton-under-Lyne (Angela Rayner), the shadow Chancellor of the Duchy of Lancaster, that we are once again having to come here to table a Humble Address to force the Government to come clean with the British public. It is all about transparency, and there are questions that need to be answered. Conservative Members can either support today’s binding vote to force Ministers to come clean, or they can be complicit in the continuing cover-up. The choice is theirs, and their constituents are watching.
The VIP lane is a national scandal that will cast a long shadow for years to come. It takes us back to the dark days of 2020 when covid was spreading, when people were dying and when there was not enough PPE for frontline workers. Schools donated goggles. Volunteers sewed gowns in their homes. Nurses and care home  workers had to resort to wearing bin bags. My hon. Friends the Members for Blaenau Gwent (Nick Smith), for Brent Central (Dawn Butler), for Bradford West (Naz Shah), for Nottingham East (Nadia Whittome) and for Llanelli (Dame Nia Griffith) have articulated well the anger that is felt by our constituents across the country, who want to have their questions answered.
The shift to procurement was necessary; no one is denying that. We had to have fast procurement, but that did not need to lead to all procurement procedures being jettisoned along the way, resulting in the failure to provide usable PPE, the granting of huge contracts to shell companies, the industrial-scale waste of taxpayers’ money and then an industrial-scale cover-up. A total of £12.6 billion was spent on PPE, but £8 billion of that was written off. We know that £4 billion-worth of PPE was not up to standard and was unusable, that £3.6 billion-worth of contracts raised one or more red flags for possible corruption, according to Transparency International, and that 176 contracts worth £2.6 billion are now in legal dispute.
The consequences continue, as we have heard from Members today. Up to three weeks ago, £770,000 was being spent every day to store the faulty PPE here and in China. I had to check that several times; it could not be right. Were we really spending £770,000 every day? That was over £5 million a week, or £280 million a year. That is enough to pay for free school meals for all the primary schoolchildren in Manchester, Birmingham, Leeds, Liverpool and Nottingham put together, or to pay 8,000 nurses a year. I have heard the clarification from the Minister that the amount has been reduced, and that is welcome, but we are still spending £400,000 a day and 120 million PPE items are being stored in China. What is going on? I speak today for the millions who are sat in freezing homes relying on food banks during this cost of living crisis and hearing that Britain is being ripped off by the Tories.
The British Medical Association’s chair of council said:
“The deadly mismanagement around the supply of PPE is one of the greatest failings of this Government’s handling of the pandemic”.
There must be a reckoning.
The Government had been in power for a decade when covid began, but they did not have good enough emergency plans in place, which is why they did not have enough stockpiles of PPE and had to panic buy. They bypassed existing, scaled-up, British-based providers of PPE, and they chose shell companies that had no experience. They gave huge contracts and jettisoned good contracting procedures. Other countries managed to do it at the time, and we should have been able to do it, too.
It is fair enough to move to emergency contracting, to streamline and speed up contracting, but no checks on companies? No checks to see if the masks met NHS standards? Did no Minister intervene and say, “This is not right. Emergency procurement procedures do not mean no procurement procedures”? Did no Minister say, “Assure me that these companies can deliver. This is taxpayers’ money”? Did no Minister say, “Assure me that the VIP lane is not being used by mates, donors and pub landlords to get contracts ahead of actual PPE contractors”? Did no Minister say, “Assure me that the contracts ensure the taxpayer will not pay for faulty PPE”? It seems not.
What happened was wrong, and it is disappointing that Ministers keep defending it. If Ministers do not own this and admit it was wrong, they will not make the necessary changes, and it could well happen again. Everyone in the country knows it to be true that the first instinct of the Conservative party, if there were another pandemic or emergency tomorrow, would not be to go to correct procurement procedures and to make sure that our taxpayers’ money is not spent wrongly.
I will tell the House about two types of company. The first is Arco, and Members have talked about others. Arco is a Hull-based market leader in PPE production. It has 135 years’ experience, works with 110,000 customers and holds key framework agreements, including with NHS Supply Chain. It is very experienced in providing expert advice and appropriate and compliant PPE during epidemics, including foot and mouth, mad cow disease, swine flu and Ebola.
Arco has its own accredited product assurance lab, a 400,000 square foot national distribution centre and a sourcing team based in China. All of that was in place at the beginning of covid. It had PPE of the required standard manufactured and ready to go. It contacted the Government, and what was the reply? It was ignored. Its offers went unanswered.
PPE Medpro was not even a company until May 2020, yet it was awarded a £120 million contract to provide 25 million gowns and a £81 million contract to provide face masks. PestFix was a pest control company with net assets of £18,000 in 2019. Its director, Joe England, met the chief commercial officer of the Department of Health and Social Care, Steve Oldfield, at the 80th birthday party of Mr Oldfield’s father-in-law. PestFix was referred to the high-priority lane and went on to win nearly £350 million of contracts but was fined £70 million for delivering faulty masks and gowns.
There was the mobile phone case designer that recorded a £1 million loss in 2019 but was referred to the high-priority lane by a former Conservative party chairman and received a £13 million contract to provide PPE. Meller Designs was a fashion accessory company, but it was referred by the right hon. Member for Surrey Heath (Michael Gove)—David Meller was a donor to his leadership campaign in 2016—and it received £170 million of contracts.
Ayanda Capital was a family investment firm specialising in currency trading, offshore property and private equity—an obvious go-to for supplying PPE. It was referred by Andrew Mills, an unpaid adviser to the Board of Trade, which is chaired by the right hon. Member for South West Norfolk (Elizabeth Truss)—I advised her that I would be mentioning her. The problem is that Ayanda Capital provided £40 million-worth of unusable face masks, yet it still posted a £25 million gross profit in 2020. The list goes on.
What do we need instead? We need a national resilience strategy. We need a procurement Bill that is not full of loopholes. We need a whole-system approach, not this mad panic and “pick your mates to make money” approach. That is why this matters, and it is why we are asking to see the documents. I hope the whole House will support this motion and ensure that the Government get the most basic responsibility of Government right, which is to keep us safe.

Neil O'Brien: To make sure that I get to them, I want to respond to some of the important points made by Back-Bench Members at the start of my remarks. The hon. Member for Kingston upon Hull East (Karl Turner), who is sadly no longer in his place, mentioned Arco not getting a contract. My understanding is that it did get a contract, so we should resolve what is correct.
The hon. Member for Argyll and Bute (Brendan O’Hara) mentioned the two different contracts for PPE Medpro, and it is important to be clear that one of those contracts was delivered—the PPE was delivered and that was fine—and one did not, and that is the one we are taking enforcement action on. With all these contracts, we are just as keen as everybody else to make sure that we get good value for money for taxpayers and we enforce whenever things have not been delivered.
The hon. Member for Blaenau Gwent (Nick Smith) called for the publication of details of companies that were in the high-priority group and then got contracts, which is something that happened in November 2021. I slightly disagree with one point that the hon. Member for Bradford West (Naz Shah) made: the argument that we should not have had any contracts with firms that had not previously been PPE suppliers. Of course lots of new firms were coming into the market, and part of our drive to get more UK supply relied on that very point.

Nick Smith: rose—

Neil O'Brien: I am just going to complete my tour of people’s contributions.
The hon. Member for Brent Central (Dawn Butler) said that we should donate and reuse PPE, and I am pleased to tell her that that is precisely what we are doing. The hon. Member for Edinburgh West (Christine Jardine) said that we are in the middle of a major cost of living issue, and she is absolutely correct. That is why we are spending £55 billion on energy support, why we have the £900 payment for 8 million poorer households and why we are raising the national living wage to a record level—that is worth about £1,600 for a full-time worker.
The hon. Members for Blackburn (Kate Hollern) and for Llanelli (Dame Nia Griffith)—

Several hon. Members: rose—

Neil O'Brien: I will give way, but I am trying to respond to everyone’s points first. If Members can hold on, we will get there.
As I was saying, those two Members both made the point that we wanted to get more UK producers making PPE. The Minister of State, Department of Health and Social Care, my hon. Friend the Member for Colchester (Will Quince), has already made the point that we have gone from 1% of FFP3 masks being made in the UK to 75%. I should also mention our work with Moderna to get more development and production of vaccines happening in the UK as part of that exciting deal.
The hon. Member for Glenrothes (Peter Grant) said that one potential supplier had been incandescent with rage because they did not get a contract. That is the system working. People were being turned down for  contracts; 90% of those who went through the—[Laughter.] Madam Deputy Speaker, I am desperately trying to respond to all the points. [Interruption.]

Eleanor Laing: Order. Give the Minister a chance to respond to all the questions. I have tried to give enough time for that, so let him get on with it.

Neil O'Brien: Thank you, Madam Deputy Speaker. I am keen to reply to them. The hon. Gentleman said that only 3%—

Peter Grant: rose—

Neil O'Brien: I am literally responding to the hon. Gentleman. He talked about only 3% not being reusable and implied that some of the other things were only fit for servicing a car. To be clear, some of these things have a different clinical use. For example, the NHS tends to use and wants to use aprons on a roll when there is the choice, where we have a normal PPE market. What we do therefore is use the flat-pack ones that we had and donate them to care homes. Self-assembly visors are not preferred in the NHS because they take a bit of time to assemble, so we give them to dentists and the like.
We have heard two different uses of the words “writing off” in this debate, and it is important to be clear about the difference between these two things. Some people talk about “writing off” for things that are not usable, and only 3% of what was purchased is in that category. Then there is a different accounting use of “writing off”, which is something we have to do; we bought a load of PPE because we needed it in the middle of the pandemic and it was more expensive at that time—it was worth more then than it is now. That is the accounting meaning of “writing off”. Let us be clear about those two different uses.

Several hon. Members: rose—

Neil O'Brien: There are so many questions that I do not know who to give way to, but I think I should start with the hon. Member for Blaenau Gwent.

Nick Smith: I thank the Minister for giving way. He attributed comments to me that I did not make, and I just want to put that on the record. I do have a question for him: does he accept that excessive profits have been made on the back of some of these PPE contracts?

Neil O'Brien: I am about to explain the due process that we went through and the incredibly forensic work that our civil servants did. Just to be clear—again, for the benefit of the House—Ministers did not make decisions on contracts. Officials, as usual, made the decisions on contracts. I will talk more about the process that we went through in the very short time that we have remaining.
During the dark days of the pandemic, we had a collective approach that saw hundreds of millions of life-saving vaccine doses delivered, the largest testing infrastructure in Europe established from a standing start and the distribution of tens of millions of items of PPE. It was a uniquely complex challenge even in normal times, but a particular challenge when the entire world was trying to get these goods. [Interruption.]  Opposition Members might want to have the courtesy to listen to the answers of the questions that they have asked—a strange approach.
We delivered 20 billion items to the frontline and to our broader workforce—we are still in fact delivering 5 million items a months. That was enough to deliver a response to a worst-case scenario, which, fortunately, did not emerge. That is why we have that 20% excess stock that I mentioned earlier. It is simply not the case, as one hon. Member mentioned, that we had five times too much PPE. However, let us remember the context. It was the former Leader of the Opposition, the right hon. Member for Islington North (Jeremy Corbyn), who said that it was a “matter of safety” and of patients’ safety. We agreed, which is why we acted. It was the shadow Health Secretary who said:
“Our NHS and social care staff deserve the very best protective clothing…and they urgently need…it.”
We agreed. It was the current shadow Chancellor who called for a
“national effort which leaves no stone unturned”.
That is exactly what we did. [Interruption.]

Eleanor Laing: Stop shouting!

Neil O'Brien: What did the hon. Member for Brent Central say there? [Interruption.] No, she does not want to repeat it.
Let me be clear, Madam Deputy Speaker: at every point in the procurement process, the process is rightly run by our brilliant commercial professionals. Ministers are not involved in the procurement process; Ministers are not involved in the value of contracts. Ministers are not involved in the scope of contracts, and Ministers are not involved in the length of contracts. That is something echoed by the National Audit Office, whose report concluded that the Ministers had properly declared their interests and that there was
“no evidence of their involvement in procurement decisions or contract management”.
The role of Ministers was exactly what we would expect. Approaches from suppliers were passed on to civil servants for an independent assessment. Let us again look at the scale of the effort: 19,000 companies made offers, around 430 were processed through the high-priority group, and only 12% of those resulted in a contract for 51 firms. That group was primarily about managing the many, many requests that were coming in to Ministers from people across the House and from people across the country who were desperate to help with that national challenge of getting more PPE, and there had to be a way of dealing with them. To be clear, due diligence was carried out on every single company, financial accountability sat with a senior civil servant, all procurement decisions were taken by civil servants, and a team of more than 400 civil servants processed referrals and undertook due diligence checks. It was a huge operation run by the civil service, and I thank them for their work in getting our NHS the PPE that it needed.
Let me be clear, I will not stand here and say that there are not any lessons to be learned; of course there are. But we should be clear about what those lessons are. Despite the global race to get PPE, only 3% of the  materials sourced were fit for purpose, but we have built more resilient supply chains. We are implementing the recommendations of the Boardman review of pandemic procurement in full. I have mentioned the growth of UK procurement of face masks and of vaccines.
In closing, I wish to thank all of those who have been involved in this important conversation. We should be rightly proud of what was achieved during those dark and difficult days at the start of the pandemic, operating in conditions of considerable uncertainty. We were in a situation where, literally, there was gazumping going on. If people did not turn up with the cash, things were removed that they had bought from the warehouses. That was the global race that we were in to source these things. The 400-strong team of civil servants who led this process did a remarkable job from a standing start of sourcing the goods that we needed.
During this debate, we have heard a number of deliberate obfuscations of the different things that Ministers and officials do. To be clear, all of these decisions went through an eight-stage forensic process that was run entirely by officials and it did not get anyone a contract to go into this high-priority group. It was simply about managing the sheer number of bids for contracts that were coming in to people across this House. At the time, although memories are very short and the barracking on this continued—

Alan Campbell: claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Question agreed to.
Main Question accordingly put and agreed to.

Eleanor Laing: Order. It is inadvisable for people to shout other things if I am listening for the Ayes having it.
Resolved,
That this House –
(a) notes that the Department for Health and Social Care purchased more than £12 billion of Personal Protective Equipment (PPE) in 2020-21;
(b) regrets that the Government has now written £8.7 billion off the value of this £12 billion, including £4 billion that was spent on PPE which did not meet NHS standards and was unusable;
(c) is extremely concerned that the Government’s high priority lane for procurement during the pandemic appears to have resulted in contracts being awarded without due diligence and wasted taxpayer money;
(d) considers there should be examination of the process by which contracts were awarded through the high priority lane; and
(e) accordingly resolves that an Humble Address be presented to His Majesty, that he will be graciously pleased to give direction that all papers, advice and correspondence involving Ministers and Special Advisers, including submissions and electronic communications, relating to the Government contracts for garments for biological or chemical protection, awarded to PPE Medpro by the Department for Health and Social Care, references CF-0029900D0O000000rwimUAA1 and 547578, be provided to the Committee of Public Accounts.

Business without Debate

Delegated Legislation

Motion made, and Question put forthwith (Standing Order No. 118(6)),

Exiting the European Union (Animals)

That the draft Trade in Animals and Related Products (Amendment and Legislative Functions) Regulations 2022, which were laid before this House on 20 October, be approved.

Animals

That the draft Animals and Animal Health, Feed and Food, Plants and Plant Health (Amendment) Regulations 2022, which were laid before this House on 20 October, be approved.

Financial Services

That the Money Laundering and Terrorist Financing (High-Risk Countries) (Amendment) (No. 3) Regulations 2022 (SI, 2022, No. 1183), dated 14 November 2022, a copy of which was laid before this House on 14 November, be approved.—(Robert Largan.)
Question agreed to.

Eleanor Laing: Order. We cannot continue to make all this noise when I am on my feet.

Public Accounts

Ordered,
That Angela Richardson be discharged from the Committee of Public Accounts and Mr Simon Clarke and Jill Mortimer be added.—(Sir Bill Wiggin, on behalf of the Committee of Selection.)

Public Administration and Constitutional Affairs

Ordered,
That Jackie Doyle-Price be discharged from the Public Administration and Constitutional Affairs Committee and Jo Gideon be added.—(Sir Bill Wiggin, on behalf of the Committee of Selection.)

Petition - Access to NHS Dental Care in Blackpool

Scott Benton: I am pleased to present this petition on access to NHS dental care in Blackpool. It has been signed by more than 790 residents, but it is on behalf of the thousands of my constituents who are currently without an NHS dentist. It is clear that urgent reform of the current dental contract is required to incentivise dentists to practise in areas such as Blackpool.
The petition states:
The petitioners therefore request that the House of Commons urge the Government to act quickly to improve access to NHS dental care in Blackpool.
[Following is the full text of the petition:
The petition of the residents of the constituency of Blackpool South,
Declares that petitioners are concerned about the lack of access to NHS dental care in Blackpool; notes that that many residents have been unable to find an NHS Practice currently taking on new patients, leaving them unable to access routine and urgent treatment.
The petitioners therefore request that the House of Commons urge the Government to act quickly to improve access to NHS dental care in Blackpool.
And the petitioners remain, etc.]
[P002786]

Responding to MPs’ Queries:  DWP Performance

Motion made, and Question proposed, That this House do now adjourn.—(Robert Largan.)

Peter Grant: Before I begin, I hope it is in order, Madam Deputy Speaker, for me to place on record my hearty congratulations to my hon. Friends the Members for Aberdeen South (Stephen Flynn) and for Paisley and Renfrewshire South (Mhairi Black), who have just been announced as the new leader and deputy leader of the SNP group here in Westminster. I offer my congratulations to both of them.
I am grateful to have the opportunity to raise in the House the woeful performance of the Department for Work and Pensions in responding to queries from Members of Parliament. I was particularly keen that the debate title should cover not simply correspondence, but all forms of communication—or non-communication—because the Department’s repeated failure to put in place a reliable and efficient way for MPs and our caseworkers to phone with urgent inquiries and speak to someone who actually understands the case is a recurring theme that I know causes immense frustration for MPs of all parties.
Let me quote just one of the many constituency cases I could refer to. Alison has a job, but it is low paid, so she gets universal credit and should have got her cost of living payment in July. It did not arrive. That, remember, is money that the Government have accepted she absolutely needs in order to make ends meet. By early September, Alison contacted my office in desperation. She told us that she had stopped the payments for her rent, council tax and internet service, that within 10 days she had to cancel her car insurance and that she was being referred to sheriff officers for council tax arrears.
My caseworkers went through the whole rigmarole of phoning and emailing all the right addresses at DWP, but they could not speak to or correspond with the people who were responsible for making Alison’s payment. None of the people my staff were allowed to speak to had any authority, even to ask for her payment to be prioritised. Two promised payment dates were not kept. Alison eventually received the money she was owed on 28 October, over three months late.
It is not the fault of overworked DWP staff that they could not do anything to help; it is the fault of the way the DWP has chosen to make it unnecessarily difficult for MPs to do our job of providing support to constituents in need. For Child Maintenance Service casework, our staff have access to an MP hotline and a dedicated email address. Until 2020, there was an MP hotline for working-age benefits such as jobseeker’s allowance, employment support allowance and income support. That gave my caseworkers and others a direct line to the local, regional and national complaints resolution team—based in Glasgow in this case—where staff had access to the various benefits systems and could contact other DWP departments with queries and to chase responses. The team was also contactable directly by email.
With the introduction of universal credit, that hotline became less useful—although the DWP staff at the other end continued to do the best they could. Eventually,  the hotline for working age benefits just disappeared altogether—but the casework certainly did not. The current confidential list of all MP hotline contacts says in big bold letters, near the top of the DWP section:
“There is no MP hotline for Universal Credit”.
The question has to be: “Why not?” Similarly, the retirement services hotline was removed, although it was reinstated earlier this year after a lot of pressure from my office and a great many others. Sometimes, if the wheel squeaks often enough, it gets the grease.
Those hotlines and dedicated email addresses are not a perk for Members of Parliament; they are not some sort of freebie. For our constituency staff, whose workloads are heavy enough as it is, there is a massive difference between being able to phone and speak now to someone who understands the problem and can access the system, look at the details of the case and get someone to fix it straightaway, and waiting for an hour or more to speak to someone who is not allowed access to the constituent’s full record and who, because of their lack of experience or because their specialism is elsewhere, probably would not understand the complexities of the case even if they were allowed to see the details.

Jim Shannon: Will the hon. Gentleman give way on that point?

Peter Grant: I believe there would be major repercussions—PARLYapp would probably go into meltdown—if I declined to take the intervention.

Eleanor Laing: Not from me. [Laughter.]

Jim Shannon: I commend the hon. Gentleman for securing the debate. Although it is sometimes frustrating when our queries are not answered, we must appreciate all the highly skilled workers working in Government Departments and external agencies. Does he agree that to deal with delays in correspondence, we must ensure that those employed within Departments are able to deal with all issues presented to them, with the knowledge and ability to prevent delays and get queries answered?

Peter Grant: That is absolutely correct. I would not for a second want my comments to be taken as any sort of slight about the dedication and professionalism of staff at the DWP. There are simply not enough of them, and they do not have access to the information that they need. In fact, I would like to flag up some of them for special praise, but I am worried that the way in which they are being so helpful to my caseworkers is maybe beyond what the DWP thinks they should be doing, and I certainly would not want to get them into trouble for being too good in helping my constituents.
The way my office operates is that, when necessary, everyone in my staff takes on casework, so when I refer to my caseworkers, I mean everybody on my staff team. Every one of them does a fantastic job—as do the caseworkers of MPs right across the House—often delivering truly life-changing results for vulnerable people. I know that my constituents value them almost as much as I do—they could not value them more. But their performance is dragged down when they cannot get the answers that my constituents deserve.
Alan was diagnosed with a chronic and incurable medical condition, and was advised that he should claim employment support allowance, which he did online through his universal credit journal. He contacted us when he got no response. My caseworker emailed the only available email address—the generic DWP correspondence address—on 25 March, and on 26 April, 3 May, 25 May and 7 June. During that time, Alan told us that he had finally got his ESA but that it was not backdated. The DWP knew that we had been in contact about this, but it never came back to my office to tell us that Alan had got the money—well, he did. The DWP came back to us in November, months and months later.
When we got a reply on 21 July to my first two emails, whoever sent the reply had not been told about my three other emails, so I got a reply in July that did not mention the other emails I had sent—two in May and one in June. They explained how Alan’s payment had been calculated. It turned out to be correct. We thought he had been underpaid, and in this case we got it wrong and the DWP got it right. If there had been a properly supported ESA hotline we and more importantly Alan would have been told exactly how much he was entitled to and exactly when it would be paid in a single phone call almost four months earlier.
In response to Alan’s case and many others, I drafted a letter to the then Secretary of State asking for the ESA hotline to be reinstated. Some 63 MPs from, I think, every party represented in the House signed it, and I am grateful to each and every one of them. The letter went in on 29 July. Two reminders and nearly five weeks later we got a response, which stated:
“It is currently not possible to provide a date upon which the issue of the MP Hotline might be resolved.”
After I had applied for this Adjournment debate, my office received a copy of a letter dated 23 November 2022 referring to the joint letter of 29 July and stating that the working-age benefits hotline had been re-established. I did not remember seeing that letter come in—that is nothing unusual; I often do not—but what was unusual was that no one in my office knew anything about it, and they do not let these things slip.
I checked with colleagues who I knew had co-signed our letter. They confirmed that the reply had been sent out by email to all the joint signatories, but when they looked at the email circulation list, my name had been missed out. I do not know who else had been, but the person who initiated the letter had been omitted from the circulation list for the reply. The DWP had forgotten to tell me about its improved communication with MPs.
Sure enough, the latest online edition of the list of MP hotlines shows an “MP hotline for working-age queries only”. It is open for a three-month trial. We are already nearly one month into that, and to the best of my knowledge the DWP has not told anyone about it apart from the 63 MPs—well, 62 excluding me—who signed my letter. About 10% of MPs have been specifically alerted to the existence of this hotline. It will be no surprise if it does not get much use if nobody knows about it.
One firm request to the Minister is to give the new hotline a fair trial and to make sure that every MP is told about it in a simple dedicated email. The Government  should not just assume that our caseworkers will check the intranet every time they want to speak to a civil servant or Department, just in case a new hotline has been established since yesterday. They should make it a proper trial of at least three months in real time after they have told MPs about it, and not including the Christmas and new year period. Most importantly, if they are going to call it an MP hotline, please provide the staffing and systems support to make it a proper hotline.
Anyone looking at the list of hotlines would not know it, but the working-age hotline in the exact words of the DWP is only
“for non-complex general enquiries that can be answered with little interrogation of our systems…Enquiries or complaints requiring thorough investigation”—
which is about 95% of DWP casework in my experience—
“should be submitted in the usual way by e-mail to”
and it then gives the standard DWP email address that my office has to wait five months for a reply from. That phrase
“can be answered with little interrogation of our systems”
looks to me very like saying that they will be able to answer general questions about the rules and regulations, but we will have no way of finding out why, for example, Alison went through months of utter misery or why Alan was not entitled to as much as he had thought. In other words, it is not a hotline at all.
Now that the DWP has been good enough to tell my staff about the hotline, I know they will use it. I am willing to be proven wrong and will even come to the Chamber and say I was proven wrong if it turns out to be working effectively, but it has all the hallmarks of a trial that has been set up to fail.
To conclude, when a Member of Parliament takes up a DWP benefits case on behalf of a constituent, there is a very strong probability—these days it is even stronger than before—that the constituent is already at the end of their tether and of their money. Often they will literally have no money and nobody but the loan sharks to fall back on if the DWP does not deal with their case quickly and effectively. Waiting weeks for any kind of reply is immensely frustrating for MPs and our staff—it wastes a lot of our staff’s precious time—but it can be much worse for the people we are here to serve. It can mean they are being denied the basics and the simple human dignity that any benefits system should surely be designed to protect. No Member of this House would ever tolerate their constituents being treated as badly as my constituents have been treated by the DWP’s inability to communicate properly with me or my staff. I certainly will not, and I look forward to hearing the Minister’s response.

Guy Opperman: I congratulate the hon. Member for Glenrothes (Peter Grant) on securing this debate on a very important issue. I assure him that the Government take this issue extremely seriously, and that does not just apply to the Department for Work and Pensions; all parts of Government take the issue of Members’ correspondence on behalf of their constituents very seriously, and in the DWP we certainly do.
I want to start with two preliminary comments before I get to the nuts and bolts of the hon. Member’s important speech. First, I congratulate the hon. Member  for Aberdeen South (Stephen Flynn) on his recent election and pass on the Government’s congratulations to him; I look forward to seeing him at Prime Minister’s Question Time tomorrow. Although this is a Scottish debate, it is only right, when we have an opportunity at the Dispatch Box, to congratulate the England football team and the England cricket team on their triumphs in Qatar and Pakistan respectively. We should not forget the beating that we hope to hand out to Monsieur Macron and his fellow Frenchmen on Saturday.
The hon. Member for Glenrothes is right to have high expectations of responses to communications that are submitted to the Department for Work and Pensions. As I will set out, in the vast majority of cases the DWP sends out timely replies. However, I accept and understand the frustration that all Members of Parliament, whether Government or Opposition, feel when the Department has not responded in the right way. We have worked constructively with Members on many occasions, and I am proud to serve in a Department with tens of thousands of people who are doing a fantastic job to deliver an awful lot of public services across this great country. In total for 2022-23, Department for Work and Pensions support and services represent £224 billion of public money, which is 9% of all GDP. That reflects the enormous force for good that the Department for Work and Pensions is and, as the hon. Member for Strangford (Jim Shannon) set out, the energy and efforts of thousands of DWP colleagues every single day to support people up and down the country, to change and improve lives. We should put on record our thanks for their sterling efforts.
I want to turn to covid, because many of the problems that the hon. Member for Glenrothes rightly identifies date back to the pandemic. We saw the degree of support that the Department gave during the pandemic, with enhanced universal credit to literally millions of extra people and masses of extra work coaches coming in, and there is unquestionably a context for why some of the hotlines were subject to cessation or have taken a while to come back. If he gives me a minute or two, I will explain why.
We rightly focused during the pandemic on ensuring that we got the right support to those who needed it quickly. That included, for example, responding effectively to the doubling of universal credit claims across the country and helping people to move back into work following the pandemic. We also had to make operational decisions, which ultimately are made by Ministers but fundamentally are made by the operational teams that run big Departments such as the DWP. A significant number of colleagues who would ordinarily be handling complaints and MP correspondence were redeployed to essential frontline services.
As part of that, the Department took the decision to temporarily suspend the retirement services hotline, while the disability services hotline was redirected to an answer machine, which was checked, and there was no change to the child maintenance hotline. To ensure that the Department continued to deliver a complaints service during this time, we brought all remaining complaints handlers together into one new centralised DWP complaints team. We also introduced a triage process that allowed us to prioritise complaints from our most vulnerable customers and those relating to payments. The centralisation of the complaints service meant that working-age and  universal credit complaints teams were no longer aligned to individual districts. That may potentially have had an impact on any local arrangements between complaints team and MPs. However, the focus at that time was simply on supporting frontline delivery in the middle of a pandemic, with all the complications of running public services with the attendance of staff at that stage.
Following the pandemic, we have slowly but surely returned the handling of complaints and correspondence to service delivery areas, which has seen greater accountability and ownership and allows complaints and correspondence to be investigated by specialist complaints teams. The Department has also improved signposting on the w4mp website, which enables parliamentary staff to find the right contacts for general and case specific inquiries, and to direct complaints to a dedicated mailbox.
I will try to deal with the assertions made about MP hotlines. We now operate a number of dedicated MP hotlines in relation to child maintenance services, which continues; disability services, such as personal independence payment and disability living allowance queries; and retirement services, enabling people to raise issues on the state pension, pension credit or winter fuel payments.
Last month, we started a three-month trial of an MP hotline for queries relating to working-age benefits. This is available from 9 am to 4 pm, Monday to Friday, with a voicemail facility available outside those hours. As part of the trial, we will assess the demand for the service and ensure that it meets the needs of hon. Members and is sustainable for the Department. I assure the hon. Gentleman that his representations—most robustly made—have been taken on board about the degree to which he believes there is a demand.
We are also developing a dedicated universal credit hotline for MPs. System testing is under way and we hope to have the line up and running shortly. All MP hotlines are regularly checked during operating hours and calls from Members are answered directly or a voicemail message can be left that will be picked up and responded to as soon as possible.
The hon. Gentleman raised MP hotlines in particular, but I will briefly address other forms of communication, because this debate is about all correspondence and responses. In terms of written correspondence, as he probably knows, the Cabinet Office publishes guidance that sets out the principles that Departments must follow when handling correspondence from Members of this House, as well as peers, Members of the devolved Parliaments or Assemblies and members of the public. That includes performance response times for responding to correspondence—specifically, a timeframe of up to 20 working days.
In 2021, the Department received a total of 7,116 pieces of correspondence from Members, about 70% of which were responded to within 20 working days. The latest data from quarter 2 of this year shows that about two thirds of the correspondence received was responded to within that timeframe.

Peter Grant: Can the Minister clarify exactly what “responded to” means? All MPs—certainly everyone who has been an Opposition MP—will have had responses from Ministers that do not tell them anything. Does he mean a response that actually provides information or does an email that simply says, “Thank you for your email” count as a response within 20 working days?

Guy Opperman: I wanted to come to that point, which I will deal with in several ways. The hon. Gentleman will be aware and will understand that much of the correspondence to the Department is complex; it is not simple stuff that can be assessed. I was the Minister with responsibility for pensions for five years where the entitlement to, say, pension credit had to be assessed on a case-by-case basis. Those things take time.
The hon. Gentleman raised the letter that he wrote on 29 June. It is my strong assurance from the Department that at 10:42 on 31 August—I have the email printout here—his standard parliamentary email inbox received a specific correspondence in relation to that letter. That may have got lost in the ether, but the assertion is strongly made by the Department that it replied on 31 August at 10:42.
On the hon. Gentleman’s campaign, I applaud and endorse his work, but he will understand that, post covid, all Departments are resurrecting and reincarnating various hotlines and capabilities. I take on board one key point—obviously, I will try to answer his other point too—that it is not always possible to reply within 20 working days, and in such instances, the Department must ensure that correspondence is responded to as quickly as possible and that the correspondent is kept informed, particularly where there is likely to be a significant delay in sending a full reply. I accept that it is important to highlight that many cases that the DWP receives are complex, so it is particularly important that individual situations and circumstances are looked into carefully and properly, and that a full and considered response is given. I genuinely take his criticisms on board, however, because they are honestly made and well thought through.
I will touch briefly on other ways to communicate with the Department. On parliamentary questions, we have a 90.8% response time for named day parliamentary questions, which is 277 out of 305 over the last period, and for ordinary written questions, there is a 93.5% response time, which is 389 out of 416.
The hon. Gentleman raised a number of other specific matters. I totally accept that, on the one key point about his ongoing treatment and how it is handled, the individual Minister who deals with correspondence at the Department for Work and Pensions, as he knows because we discussed this earlier, is Baroness Stedman-Scott in the other place. If there are any matters arising out of this, she will go through them and write to the hon. Gentleman—in good time, I hasten to add—to ensure that a proper response is given.
I want to contextualise two other quick points, and I have a little time. The first is that all efforts by the Department need to be judged against the background of covid and the background of the cost of living support. This is the Department that has had to deal with the £37 billion package set out by the Chancellor in May. That includes, as we all know, the £650 cost of living support, the £300 extra winter fuel payment and the £150 disability cost of living payment. We have had to find people and use them to deliver all those things, which is a massive enterprise. While the hon. Gentleman is right to have legitimate criticism of individual cases, they have to be seen in that context.
On top of that, the hon. Gentleman will be aware that, in the September sitting of Parliament and then subsequently in the 17 November autumn statement,  again a vast amount of things were brought forward, ranging from the further energy support package to the extra cost of living support and the energy price guarantee. Those are all things that have had to be brought forward and actioned by the Department for Work and Pensions.

Iain Duncan Smith: rose—

Guy Opperman: Of course I give way to my right hon. Friend, who was the Secretary of State for six years.

Iain Duncan Smith: I apologise to the hon. Member for Glenrothes (Peter Grant) for not being here earlier, but I did let him know that I was delayed.
May I say with the deepest respect, because nobody respects the Department more than me, that I just do not think this correspondence is working? We got a call in my office the other day to say that it would not now be writing to us, because people were too hard-pressed in the Department to write to anybody and they would make a quick call. We did not want a call; we want correspondence. When I was in the Department, the Secretary of State and Ministers all signed off their own correspondence, and nothing went out of the door that they had not read and checked. That had added value in that we knew what was going on in the Department. Each Minister should sign off every single bit of correspondence to MPs, and anything else is simply substandard, if the Minister does not mind my saying so.

Guy Opperman: I take my right hon. Friend’s point very seriously, and we will look into that specific point. I am not aware of the individual example of course, but we will definitely reach out to his office tomorrow to ensure that we get chapter and verse on that specific case. He will know and understand—and I am not disputing that we need a verification of his particular case—that responses in certain cases are handled by officials and responses in other cases are handled by Ministers and the Secretary of State. I cannot possibly comment on the nature of this case, but it is very traditional and usual for anything from a Member of Parliament to be responded to by the Member of Parliament who happens to be a Minister or the Secretary of State. That is clearly the normal way, but I will look into this and make sure that Baroness Stedman-Scott writes to him promptly and investigates the matter forthwith.
I want briefly to touch on two final points. On FOI handling, there was a 97% response time for quarter 1 and a 96% response time for quarter 2. On the correspondence guidance, clearly the hon. Member for Glenrothes can hold the DWP to account, but a whole bunch of guidance is set out for all Departments—it is published quarterly, and it is available both in the House of Commons Library and on gov.uk—from which he can see a comparison of this Department with other Departments.
While the statistics show that most Members do receive timely replies from the DWP, there is clearly room for improvement, and I take that on board. We closely monitor that performance, we take on board the points raised by those on both sides of the House, and we will ensure that things are done better in the future.
Question put and agreed to.
House adjourned.